Nutrient intake of obese female binge eaters

OBJECTIVE

To compare the 6-month change in selected nutrients and number of binge days (from 7-day food records) between obese binge eaters randomly assigned to either a behavioral self-management (BSM) or waiting list control (WLC) group. Within each of the 2 groups, the average intake of selected nutrients on binge and nonbinge days at baseline and at 6 months were compared.

DESIGN

A randomized, controlled, intervention study with assessments at entry and 6 months later.

SUBJECTS

Forty-six women in the BSM group and 36 in the WLC group completed the 6-month measurement. Participants were 25 to 50 years of age, 30 to 90 pounds overweight, did not have a history of physical or psychological illnesses, and scored 20 or greater on the binge eating scale.

INTERVENTION

Participants in the BSM intervention received 6 months of weekly, 1-hour classes taught by registered dietitians. Participants in the WLC group were not contacted during the 6 months.

OUTCOME MEASURES

The main outcome measures were change in energy consumed (kilocalories); percentage of energy from fat, protein, and carbohydrate; grams of fiber/1,000 kcal; and change in the number of self-reported binge days.

STATISTICAL ANALYSES

Weight at 6 months was compared using a 2-sample t test. The change in the number of binge days at 6 months and the amount of change in selected nutrients by group was compared using the 2-sample t test. The paired t test was used to compare the average nutrient intakes on binge and nonbinge days within groups.

RESULTS

No significant difference was found in the 6-month change between groups in any of the selected nutrients. The BSM group reported a greater reduction in binge days between baseline and 6 months compared with the WLC group (mean 1.0 vs 1.7, P < 0.03). Within the BSM group at 6 months, energy intake and percentage of energy from fat on nonbinge days were significantly reduced compared with binge days. At baseline within the WLC group, energy intake increased and percentage of energy from protein decreased significantly on nonbinge days compared with binge days. Within the WLC group at 6 months, energy intake and percentage of energy from fat significantly decreased and percentage of energy from protein significantly increased on nonbinge days.

CONCLUSIONS

Our results suggest that collecting dietary information from participants identified with binge eating disorder is challenging. Dietitians who conduct behavioral weight management programs may require additional training in identifying and understanding the psychological characteristics of participants with binge-eating disorder.

Measurement of dietary intake in the UNC Alumni Heart Study. University of North Carolina

BACKGROUND

Research needs to identify diet and disease associations to provide direction about effecting change in individuals with dietary behaviors that increase risk of chronic disease. Inclusion of dietary assessment in the University of North Carolina Alumni Heart Study (UNCAHS) provides the opportunity to prospectively investigate dietary intake and chronic disease associations with measures of personality and behavioral risk factors.

METHODS

Development of the UNCAHS food frequency questionnaire and nutrient intake of 4,443 middle-aged men and women is provided stratified by total fat and vitamin A intake within demographic and health behavior categories.

RESULTS

Alumni consume diets close to that recommended by current dietary guidelines. Both men and women have low calcium intake. Thirty-nine percent of the alumni consume diets with 30% of kilocalories from fat or less and 88% meet the RDA for vitamin A. Never smokers had lower fat diets and greater intakes of vitamin A than former or current smokers. Over 54% of alumni currently took vitamin/mineral supplements.

CONCLUSIONS

UNCAHS participants will be tracked as they approach older ages with apparently less risk for diet-related chronic diseases than many Americans. The psychosocial correlates of these eating behaviors will be evaluated as disease endpoints occur.

Comparison of a dietary record using reported portion size versus standard portion size for assessing nutrient intake

OBJECTIVE

Because the percentage of missing portion sizes was large in the Aerobics Center Longitudinal Study (ACLS), careful consideration of the accuracy of standard portion sizes was necessary. The purpose of the present study was to investigate the consequences of using standard portion sizes instead of reported portion sizes on subjects' nutrient intake.

METHODS

In 2307 men and 411 women, nutrient intake calculated from a 3-day dietary record using reported portion sizes was compared with nutrient intake calculated from the same record in which standard portion sizes were substituted for reported portion sizes.

RESULTS

The standard portion sizes provided significantly lower estimates (>/= 20%) of energy and nutrient intakes than the reported portion sizes. Spearman correlation coefficients obtained by the two methods were high, ranging from 0.67 to 0.93. Furthermore, the agreement between both methods was fairly good. Thus, in the ACLS the use of standard portion sizes rather than reported portion sizes did not appear to be suitable to assess the absolute intake at the group level, but appeared to lead to a good ranking of individuals according to nutrient intake. These results were confirmed by the Continuing Survey of Food Intake by Individuals (CSFII), in which the assessment of the portion size was optimal. When the standard portion sizes were adjusted using the correction factor, the ability of the standard portion sizes to assess the absolute nutrient intake at the group level was considerably improved.

CONCLUSIONS

This study suggests that the adjusted standard portion sizes may be able to replace missing portion sizes in the ACLS database.

Familial aggregation of colorectal cancer in Egypt

We have investigated the familial aggregation of colorectal cancer and hereditary nonpolyposis colorectal cancer (HNPCC) in Egypt because of the high incidence of colorectal cancer in Egyptian children and young adults and the prevalence of consanguinity there. In a pilot study, we conducted detailed interviews with 111 Egyptian colorectal cancer patients and 111 healthy Egyptian controls about their family histories of colorectal cancer, and other cancers, consanguinity, age at diagnosis, symptoms and recurrence. Eight patients (7.2%) had one or more first- or second-degree relatives under age 40 with colorectal cancer, suggestive of HNPCC by the Amsterdam criteria. One of these families had a typical history of HNPCC, with 4 relatives having colorectal cancer in 3 generations; 3 of these relatives were younger than age 45 at colon cancer diagnosis, and other relatives had extracolonic tumors. Another 14 patients (12.6%) had a first- or second-degree relative with a family history of other neoplasms such as endometrial, urinary and hepatobiliary cancers that could also be related to HNPCC. Four patients with early-onset colon cancer and a family history of other HNPCC-related cancers reported that their parents were first-degree cousins.

Reduced expression of mismatch repair genes in colorectal cancer patients in Egypt

An Egyptian hospital-based pilot case-control study was conducted to investigate the relationship between the expression level of mismatch repair (MMR) genes and the risk of colorectal cancer. The relative expression of five known MMR genes, i.e., hMSH2, hMLH1, hPMS1, hPMS2, and GTBP/hMSH6, was measured by a multiplex reverse transcriptase (RT)-polymerase chain reaction (PCR) in peripheral blood lymphocytes from 31 colorectal cancer patients and 47 age- and-sex matched controls. The expression of hMSH2, GTBP/hMSH6, hPMS1 and hPMS2 tended to be lower in patients than controls, but only the difference in hPMS2 expression was statistically significant (p<0. 01). Although 50% of the cases had chemotherapy or radiotherapy within the last six months before the blood was drawn, their gene expression was not statistically different from those who had not undergone such therapies. After adjustment for age and sex, the odds ratios (OR) calculated from a logistical regression model, using the median levels of gene expression of controls as cut-off values, indicated that increased risk was associated with reduced expressions of both hPMS1 (OR = 3.97, 95% confidence interval (CI) = 1.04 to 7.65) and hPMS2 (OR = 2.86, 95% CI = 1.05 to 7.76). Although the results of this study were inconclusive because of the small sample size and use of prevalent cases, it is biologically plausible that patients with colorectal cancers may have a lower expression of MMR genes than healthy controls because malfunction of these genes has been shown in hereditary nonpolyposis colon cancer. The involvement of low hPMS2 expression in colon cancer risk seems to be unique in the Egyptian population. Further studies with newly diagnosed patients before they begin therapy will provide more convincing data about the role of MMR gene expression in the etiology of colorectal cancers in Egypt.

Validity and reproducibility of a food frequency questionnaire among Hispanic and non-Hispanic white women in New Mexico

The purpose of this study was to assess the validity and reproducibility of an interviewer-administered, semi-quantitative food frequency questionnaire (FFQ) among 132 volunteer New Mexico Hispanic (H) and non-Hispanic white (NHW) women, aged 35-74 years, with (n = 47) and without (n = 85) a breast cancer history, and to add to the limited data presently available on the performance of FFQs among different ethnic groups. Validity was measured at one month and six months from baseline against four-day food records, and reproducibility was tested by comparing FFQs. Unadjusted validity correlation coefficients were highest at one month, ranging from 0.38 (polyunsaturated and monounsaturated fat) to 0.57 (calcium); energy-adjusted correlation coefficients were highest at six months, ranging from 0.15 (polyunsaturated fat) to 0.68 (calcium). Energy-adjusted correlation coefficients were statistically significant by ethnicity for vitamins A and C, protein, carotene and calcium, and by case status for saturated fat, folate, fiber, and vitamins A and E. Reproducibility correlation coefficients (unadjusted) ranged from 0.40 (polyunsaturated fat) to 0.71 (carbohydrate, retinol); energy-adjusted correlation coefficients ranged from 0.42 (vitamin E) to 0.78 (fiber), and differed significantly by ethnicity for saturated fat and retinol, and by case status for carbohydrate. Overall, our FFQ has comparable characteristics to other FFQs and is suitable for use with New Mexico's H and NHW women.

Serum organochlorine pesticide levels in patients with colorectal cancer in Egypt

The widespread use of pesticides in Egypt, the high incidence of colorectal cancer in Egyptian children and young adults, and the published U.S. case reports in which pesticides have been connected with colorectal cancer led the authors to investigate the possible association between organochlorines and colorectal cancer. The authors conducted a pilot study to describe serum organochlorine levels among 31 Egyptian colorectal patients and 17 controls. High levels and large interindividual variability of p,p'-dichloro-diphenyldicholoroethylene (DDE), dichloro-diphenyl-trichloroanthane (DDT), beta-hexachlorocyclohexane (beta-HCH), and hexachlorobenzene (HCB) levels were found among most subjects, especially those from rural areas. Farming and aging were each associated positively with high serum organochlorines. Colorectal cancer patients had higher serum organochlorines levels than controls. The high levels of organochlorines reported and their relation to age, residence, occupation, and disease status justify further study of the possible association between organochlorine pesticides and colorectal cancer in a larger population in Egypt.

Correlates of mutagen sensitivity in patients with upper aerodigestive tract cancer

Although tobacco and alcohol use are the major determinants of upper aerodigestive tract carcinogenesis, not all smokers develop cancer. This phenomenon is due to individual variation in genetic susceptibility to carcinogens. One explanation may be differences in mutagen sensitivity (as measured by the in vitro bleomycin-induced mutagen sensitivity assay) in patients with squamous cell carcinoma of the upper aerodigestive tract. Antioxidant supplementation has also been shown to decrease DNA damage and thus may also inhibit carcinogenesis. In this study, we examined whether smoking, alcohol intake, and dietary antioxidant intake were correlated with mutagen sensitivity. The 612 patients evaluated are part of an ongoing multicenter Phase III trial of 13-cis retinoic acid for the prevention of second primary tumors. We found that patients with pharyngeal cancers were more likely than patients with oral cavity or larynx cancers to be mutagen sensitive. There were no significant differences in the distribution of mutagen sensitivity by sex or alcohol use. Never smokers were significantly more likely (61.1%) to be mutagen sensitive than current smokers (35.6%). Dietary consumption of the micronutrients alpha-carotene, beta-carotene, lutein, lycopene, and vitamin C was not correlated with mutagen sensitivity. Therefore, we suggest that mutagen sensitivity is an independent marker of cancer risk not affected by other known risk factors.

A case-control study of dietary intake and other lifestyle risk factors for hyperplastic polyps

BACKGROUND & AIMS

Despite the high prevalence of the hyperplastic polyp, little is known about its etiology. The aim of this study was to assess the relationship between diet and other lifestyle factors and the presence of colorectal hyperplastic polyps.

METHODS

Information on diet and other known or suspected risk factors for colorectal cancer or adenoma was collected among 81 subjects with hyperplastic polyps and 480 controls.

RESULTS

The multivariate-adjusted odds ratio (OR) for hyperplastic polyps for individuals in the upper vs. the lower quartile was 0.30 (95% confidence interval [CI], 0.10-0.88) for dietary fiber, 0.32 (95% CI, 0.11-0.96) for dietary calcium, 0.90 (95% CI, 0.27-2.95) for total fat, and 2.02 (95% CI, 1.05-3.91) for alcohol consumption. Compared with individuals in the lower category, those in the upper category of body mass index had a higher risk for hyperplastic polyps (OR, 4.50; 95% CI, 1.84-10.97). Cigarette smoking was associated with a higher risk (OR, 1.97; 95% CI, 1.02-3.81 for > 20 pack-years vs. never), whereas an inverse association was seen for use of aspirin and other nonsteroidal anti-inflammatory drugs (OR, 0.29; 95% CI, 0.12-0.67 for once per day or more vs. never).

CONCLUSIONS

Hyperplastic polyps share common lifestyle risk factors with colorectal adenomas and carcinomas.

Dietary surveillance for states and communities

Information about dietary behaviors, attitudes, and knowledge is important for state and local health agencies because national monitoring lacks the local representativeness and timeliness necessary to catalyze community interest and to design, target, and evaluate dietary intervention programs. Currently, however, both methods and resources are limited for surveying diet in the population of a state or community. Brief assessments are included in the Youth Risk Behavior Surveillance System for adolescents, which is conducted by state departments of education, and in the Behavioral Risk Factor Surveillance System for adults, which is operated by state departments of health. More quantitatively precise measurements are being made by a few states and communities but personnel and financial resources for such surveys are limited. Nutritionists in state and local health agencies should explore the possibility of developing public-private partnerships with food producers, retailers, and marketers to collect information about dietary determinants and behaviors in states and communities. Better standardization of dietary assessment methods is needed, as is development of better methods to identify attitudes about diet and barriers to dietary improvement. Most important, though, dietary surveillance in states and communities must be more strongly tied to intervention programs intended to improve nutrition in those populations.

Colorectal cancer in Egyptian patients under 40 years of age

Although colorectal cancer is not a common cancer in Egypt, the age distribution of the disease shows that a high proportion occurs in children and adults under 40 years of age. We reviewed the records of 1,608 colorectal cancer patients treated in 4 cancer hospitals in Egypt during a period of 3 to 10 years. The hospitals in which about 85% of all colorectal cancer cases in Egypt were seen included Egypt's 2 major cancer centers, The National Cancer Institute (NCI) in Cairo and Tanta Cancer Center (TCC) in the mid-Nile Delta region, and 2 major university hospitals, Assiut University in South Egypt and Ain Shams University in Cairo. Our review showed that patients younger than 40 years represented 35.6% of all patients in the 4 cancer hospitals, and that these rates were similar among the hospitals and for the years reviewed. The male-to-female ratio increased from 1.0 to 1.7 for the age groups ranging from 0-9 and 30-39 years, and increased from 1.0 to 1.5 for the age groups ranging from 40-49 to over 60 years. More than half of all the patients had rectal tumors, and about 90% of the cancers were adenocarcinomas; 30.6% of patients younger than 40 years, compared with 13.8% of older patients, had mucin-producing tumors. This study confirmed the occurrence of a high colorectal cancer rate in young Egyptians, and it opens the door to future epidemiologic studies to identify causes and risk factors of this disease pattern in Egypt.

Association of diet and colorectal adenomatous polyps: dietary fiber, calcium, and total fat

We conducted a case-control study to investigate the relation between dietary fiber, calcium, and total fat and the risk of colorectal adenomatous polyps. We used a food frequency questionnaire to assess the usual diet for 157 cases and 480 controls. In multivariate analyses, dietary fiber was inversely associated with risk of adenomatous polyps. The odds ratio (OR) for individuals in the highest vs the lowest quartile was 0.5 [95% confidence interval (CI) = 0.3-0.9]. We found an inverse association between dietary calcium and risk of adenomatous polyps, but the protective effect was present only for individuals in the fourth vs the first quartile (OR = 0.7; 95% CI = 0.3-1.3). Intake of total fat was positively associated with risk of adenomatous polyps, but we saw no consistent trend. Calcium intake appeared to modify the effect of total fat intake on the risk of adenomatous polyps.

Calcium supplementation modifies the relative amounts of bile acids in bile and affects key aspects of human colon physiology

Use of calcium supplements has increased dramatically in recent years yet little is known about the effect of calcium supplementation on colon physiology. We supplemented 22 individuals with a history of resected adenocarcinoma of the colon, but currently free of cancer, with 2000 or 3000 mg calcium for 16 wk. The effects of supplementation on duodenal bile acids and important fecal characteristics including total fecal output, wet and dry weight, pH, bile acids (in solids and in fecal water), and concentrations and total excretion of calcium, magnesium, phosphates (organic and inorganic), unesterified fatty acids and total fat were determined. Calcium supplementation significantly decreased the proportion of water in the stool (P = 0.03), doubled fecal excretion of calcium (P = 0.006), and increased excretion of organic phosphate (P = 0.035) but not magnesium. Calcium supplementation significantly decreased the proportion of chenodeoxycholic acid in bile (P = 0.007) and decreased the ratio of lithocholate to deoxycholate in feces (P = 0.06). The concentration of primary bile acids in fecal water decreased after 16 wk Ca supplementation. Together with other reports of a "healthier" bile acid profile with respect to colon cancer when changes such as those observed in this study were achieved, these results suggest a protective effect of calcium supplementation against this disease.

Aspirin and other nonsteroidal anti-inflammatory drugs and risk of colorectal adenomatous polyps among endoscoped individuals

Most epidemiological evidence supports the inverse association between use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) and colorectal cancer. Few studies have investigated the relation between use of aspirin and other NSAIDs and adenomatous polyps, which are recognized as precursors of colorectal cancer. We examined the association of adenomatous polyps and the dose and duration of use of aspirin and other NSAIDs in a case-control study of dietary risk factors for colorectal adenomatous polyps. The study population comprised 157 case and 480 control individuals who underwent an endoscopy at collaborating gastroenterology clinics in Houston, TX. Face-to-face interviews were conducted to obtain risk factor data that included information on frequency and duration of use of aspirin and other NSAIDs. Compared to the nonusers, the multivariate odds ratios for individuals who took aspirin and other NSAIDs on a weekly basis and for those who took these once/day or more were 0.77 (95% confidence interval, 0.39-1.55) and 0.36 (95% confidence interval, 0.20-0.63), respectively. Compared to the nonusers, the odds ratio for individuals who used aspirin and other NSAIDs for <5 years was 0.39 (95% confidence interval, 0.39-1.55) and 0.36 (95% confidence interval, 0.20-0.71), and for those who used these for 5 years or more, the odds ratio was 0.60 (95% confidence interval, 0.32-1.14). The results of this study suggest that aspirin and other NSAIDs are associated with a decreased risk for adenomatous polyps. Limited dose-response analyses found that the point estimate decreased with the frequency but not the duration of use of aspirin and other NSAIDs.

Food-frequency questionnaire validation among Mexican-Americans: Starr County, Texas

A food-frequency questionnaire (FFQ) for low-income Mexican-Americans in Starr County, Texas, was developed as part of an epidemiologic study of gallbladder disease during 1985 and 1986. The FFQ was developed from 7-day food records collected from the first sample. In the validity study, using the second sample, correlations between nutrients calculated from 3-day food records and the FFQ were 0.77, 0.76, and 0.61 for energy, total fat, and saturated fat, respectively. In the reliability study, using the third sample, for the 1-month interval between baseline and a repeat FFQ measurement correlations ranged from 0.90 for energy to 0.85 for total fat and for the 2-month interval they were 0.84 for energy and 0.70 for total fat. The high correlations are largely explained by the lack of diversity in the diets of Starr County individuals which facilitated the high agreement between the FFQ and the food records for estimates of energy, fats, and cholesterol.

Cigarette smoking and alcohol consumption as risk factors for colorectal adenomatous polyps

BACKGROUND

Results of epidemiologic studies suggest that there is limited evidence for the association between cigarette smoking and risk of colorectal cancer. Cigarette smoking has been shown to increase the risk of colorectal adenomatous polyps, which are recognized as precursors of colorectal cancer, while few studies have examined the association between alcohol consumption and the development of adenomatous polyps.

PURPOSE

We examined the association between cigarette smoking, alcohol consumption, and the presence of colorectal adenomatous polyps.

METHODS

Analyses were based on data from a case-control study of dietary and other lifestyle factors for colorectal adenomatous polyps. We assessed the risk of adenomatous polyps associated with total number of years of smoking, number of cigarettes smoked per day, and pack-years of smoking for past and current smokers separately. We also assessed the joint association between cigarette smoking and alcohol consumption on the risk of adenomatous polyps.

RESULTS

Current smokers who smoked more than 20 pack-years were at significantly higher risk of adenomatous polyps compared with never smokers (odds ratio [OR] = 2.56; 95% confidence interval [CI] = 1.28-5.14). Past smokers also had an increased risk of having adenomatous polyps, but no clear trend was observed for pack-years of smoking. Alcohol consumption was positively associated with risk of adenomatous polyps. Compared with nondrinkers, the strongest risk was observed for individuals who consumed 2.31-9.46 g alcohol per day (OR = 2.23; 95% CI = 1.29-3.83), and a decrease in risk was observed for individuals who consumed 9.47-67.36 g alcohol per day (OR = 1.63; 95% CI = 0.92-2.88). Among current smokers, a joint effect was observed for individuals who smoked and drank compared with those who never smoked and were not current drinkers (OR = 4.21; 95% CI = 1.88-9.41). For past smokers, a significant joint effect of smoking and current alcohol consumption was also observed, but the risk was not as strong as that for current smokers (OR = 2.61; 95% CI = 1.40-4.87).

CONCLUSIONS

These data provide further evidence of the positive association between cigarette smoking and the development of colorectal adenomatous polyps. The combination of cigarette smoking and alcohol consumption increased the risk of adenomatous polyps.

IMPLICATIONS

Future research should focus on the understanding of the role of cigarette smoking and alcohol consumption as these two factors relate to the evolution of colorectal adenomatous polyps and subsequent carcinogenesis.

Sexually transmitted diseases and other risk factors for cervical dysplasia among southwestern Hispanic and non-Hispanic white women

OBJECTIVE

To assess risk factors for high-grade cervical dysplasia among southwestern Hispanic and non-Hispanic white women.

DESIGN

Clinic-based case-control study.

SETTING

University-affiliated gynecology clinics.

SUBJECTS

Cases were Hispanic and non-Hispanic white women with biopsy-proven high-grade cervical dysplasia (n = 201). Controls were Hispanic and non-Hispanic white women from the same clinics with normal cervical epithelium (n = 337).

METHODS

Study design included interviews focused on histories of sexually transmitted diseases, sexual behavior, reproductive histories, hygienic practices, contraceptive use, cigarette smoking, and diet. Laboratory studies included bacterial and protozoal cultures of the cervix; hybridization tests to identify human papillomavirus (HPV) genome with commercial (ViraPap and ViraType) and polymerase chain reaction-based assays; and serum antibody tests for herpes simplex virus, Chlamydia trachomatis, syphilis, hepatitis B, and hepatitis C.

RESULTS

For both ethnic groups combined, after adjustment for ethnicity, age, and sexual behavior, the strongest risks for cervical dysplasia were associated with cervical HPV infection as identified by ViraPap (odds ratio [OR], 12.8; 95% confidence interval [CI], 8.2 to 20.0) or with polymerase chain reaction (OR, 20.8; 95% CI, 10.8 to 40.2). Other factors associated with dysplasia included cigarette smoking at the time of diagnosis (OR, 1.8; 95% CI, 1.2 to 2.8); low income (OR, 2.2; 95% CI, 1.2 to 4.0); low educational level (OR, 6.2; 95% CI, 3.4 to 11.1); history of any sexually transmitted disease (OR, 1.9; 95% CI, 1.3 to 2.7); and seroprevalence of antibodies to hepatitis B (OR, 1.8; 95% CI, 0.9 to 3.5). For Hispanic women, HPV 16/18 identified by ViraType was strongly associated with cervical dysplasia (OR, 171.0; 95% CI, 22.8 to 1280.5). Antibodies to herpes simplex virus type 2 were not associated with dysplasia in Hispanic women but were significantly associated with dysplasia among non-Hispanic whites. Risks associated with cigarette smoking also varied by ethnic group.

CONCLUSIONS

The strongest risk factor associated with high-grade cervical dysplasia among clinic attendees was HPV infection. Although most of the risk factors we examined showed similar associations for dysplasia for both ethnic groups, our data suggest that several different risk factors may be relevant to the development of cervical dysplasia in Hispanics compared with non-Hispanic whites who attend the same clinics.

Risk factors for cervical dysplasia in southwestern American Indian women: a pilot study

Cervical cancer and cervical dysplasia occur at high rates among American Indian women in the southwestern United States. Few published data, however, have addressed risk factors for the development of cervical neoplasia among southwestern American Indian women. To investigate risk factors for cervical dysplasia in this population, we carried out a case-control pilot study focused on the effects of sexually transmitted diseases, sexual behavior, hygienic practices, cigarette use, contraceptive techniques, and diet in the development of cervical dysplasia. Although our pilot study lacked power to clearly identify risk factors for neoplasia, the data suggest that cervical papillomavirus infection (crude odds ratio 4.72, 95% confidence interval 1.62-14.11), vaginal deliveries (3.70, 0.69-20.04 for > 2 vaginal deliveries vs none), and current cigarette smoking (3.08, 0.50-24.15) were associated with dysplasia. These preliminary findings indicate that risk factors for dysplasia in American Indian women differ from risks which we have identified in southwestern Hispanic and non-Hispanic white women, and suggest the need for further investigation of ethnic differences in cervical disease development.

Dietary micronutrients and cervical dysplasia in southwestern American Indian women

American Indian women in the Southwest have high rates of cervical cancer and cervical dysplasia in contrast to low rates of cancers for other sites. Despite their high rates of cervical disease, no published information has specifically examined risk factors for cervical cancer or cervical dysplasia among American Indian women. We carried out a pilot case-control study of cervical dysplasia in southwestern American Indian women to examine the relationship of dietary intake of vitamin C, folacin, vitamin E, carotenoids, and retinol with cervical cytological abnormalities. Twenty-four-hour dietary recalls were collected from women with cervical dysplasia (n = 42) and women with normal cervical cytologies (n = 58). Macro- and micronutrient intake was estimated from these recalls utilizing food and nutrient data from the USDA Survey Nutrient Database. Although mean differences between cases and controls were not statistically significant for any of the micronutrients examined, women with low intake of vitamin C, folacin, and vitamin E were at increased risk of having cervical dysplasia when the data were analyzed as stratified for level of intake (low vs. high intake odds ratios were 3.0 for vitamin C, 3.3 for folacin, and 1.7 for vitamin E). The relationship between dietary micronutrients and cervical dysplasia among American Indian women warrants further investigation using more refined measures of dietary micronutrient intake, together with consideration of other risk factors for cervical disease.

Intake and food sources of dietary fat among schoolchildren in The Woodlands, Texas

To investigate the nutrient intake and food use patterns among schoolchildren, diet was assessed among 138 children and adolescents in grades 5 through 12 using three random, nonconsecutive, 1-day food records. Mean intake of total fat, saturated fat, and polyunsaturated fat as percent of calories was 35.6%, 13.4%, and 6.6%, respectively. Among all subjects, 17% consumed diets containing less than 30% of calories from fat, 34% consumed greater than or equal to 38% of calories from fat, 7% consumed less than 10% of calories from saturated fatty acids, and greater than 97% ate less than 300 mg of cholesterol per day. While intake of calories, sodium, and beta-carotene per 1000 kcal was higher in subjects consuming higher fat diets, intake of other micronutrients was either higher among those eating low-fat diets or did not differ by level of fat intake. Differences were seen in the amount of saturated fat and cholesterol that individual food sources contributed to the diets of subjects eating high and low fat diets. These cross-sectional data show that a substantial proportion of children and adolescents in this population are consuming diets low in fat and cholesterol without systematic differences in intake of other nutrients, suggesting that current dietary guidelines regarding fat intake are attainable within the current food use pattern of healthy, school-aged children and adolescents.

Food group contributions to nutrient intake in whites, blacks, and Mexican Americans in Texas

The existence of three different ethnic groups, living within a defined geographic area in Texas and maintaining fairly distinct life-styles, provided an excellent opportunity to compare their dietary behaviors. Information about food consumption was obtained by 24-hour dietary recall from a group of 431 whites, blacks, and Mexican Americans residing in two counties in southeast Texas. Food group and subgroup contributions to 11 nutrients were calculated. The intake patterns of Mexican Americans demonstrated both an adherence to traditional or familiar Mexican food items, such as beans and tortillas, and a preference for foods not previously reported to be commonly consumed by that ethnic group, specifically beef. The current study provides a base of information necessary to implement dietary changes acceptable within the context of a particular culture's world view. Results revealed differences in food intake patterns that would be helpful in designing practical nutrition education programs specifically targeted toward these ethnic groups. For example, inadequate sources of nutrients were identified, as were sources of excess fat.

Dietary epidemiology of colon cancer

Epidemiologic studies of the relationship of diet to cancer etiology are hampered by methodologic difficulties which can be overcome by careful trial design. The use of appropriate dietary assessment instruments is necessary to minimize bias and improve accuracy of diet assessment. Population studies implicate dietary fat intake in the etiology of colorectal carcinogenesis, and the incidence of colorectal malignancies around the world is positively correlated with meat and fat consumption and total calorie intake. Retrospective studies of fat intake yield equivocal results, whereas prospective studies have failed to show a relationship between fat intake and colon cancer risk. An inverse relationship exists between fiber consumption and colorectal cancer incidence and mortality rates. The positive observational studies are supported by laboratory studies of experimental carcinogenesis which show a greater number of tumors in animals fed high-fat or high-calorie diets. Increased fiber intake appears to offer some protection against colorectal cancer. Plausible mechanisms have been proposed in animals for the role of fat and fiber in colorectal carcinogenesis; the mechanisms in human populations await further description. The interrelationships between fat consumption and consumption of dietary fiber and micronutrients have made it difficult to assess the roles of these substances in the etiology of colorectal cancer. Calcium offers protection in animal systems, and the data in humans are suggestive but not yet conclusive. Data on the role of alcohol in colorectal carcinogenesis remain inconclusive. Little evidence exists for a protective effect of retinoids and carotenoids; the evidence for selenium and vitamin C is limited and evolving.

Development of a food frequency instrument: ethnic differences in food sources

Dietary intake was assessed among 431 black, white, and Mexican American men and women in southeast Texas using 24-hour dietary recall interviews. These data were collected to provide information on ethnic-specific food sources of selected nutrients; this information was used to construct a food frequency questionnaire for a study of nutrient intake and cancer. Nutrient content of total fat, total vitamin A, and vitamin C was determined for all foods consumed and was aggregated across unique food codes. These aggregated food codes were then ranked according to the contribution of each food to the total population intake of each nutrient. Ethnic differences existed in food sources of nutrients that would not be identified if data from only the analysis of the combined data set were used. Generally, however, the food sources identified from analyses of the combined data set included those foods that were important nutrient sources for each of the ethnic groups as well.

Nutrient intakes of whites, blacks, and Mexican Americans in southeast Texas

Ethnic groups in the United States exhibit different patterns of cardiovascular disease and cancer morbidity and mortality. This has, in part, been attributed to differences in dietary intake. However, there is limited comparative information available regarding the dietary patterns of whites, blacks, and Hispanics residing in the same geographic area. Selected nutrient intakes were obtained by an interviewer-administered 24-hr dietary recall from 231 white, 102 black, and 98 Mexican-American persons residing in the same communities in Southeast Texas. Mean caloric intakes were highest for whites, followed by Mexican Americans and blacks. Mexican Americans had carbohydrate intakes that were significantly higher, but total fat intakes that were significantly lower, than those of whites. Blacks of both sexes had the highest cholesterol intakes and black males had the highest saturated fat intakes. Neither was significantly higher than that of whites or Mexican Americans. Overall, the mean vitamin A and C values were highest for blacks and lowest for whites, although the differences were not statistically significant. Mean calcium and phosphorus intakes were significantly higher for whites compared with those for blacks and Mexican Americans. Blacks had significantly lower mean fiber values than whites or Mexican Americans. International ethnic differences in disease distribution have long been used to provide clues to etiologic factors. National ethnic differences in disease distribution related to dietary intake can further elucidate these causative and/or preventive factors. However, to do so will require additional attention to dietary methodology of the type presented here.

Estimating prevalence of adverse reactions to foods: principles and constraints

Future research in the area of adverse reactions to foods should use the basic principles of epidemiology to allow the prevalence of these adverse reactions to be established. The process of incorporating these principles into future research will aid in the identification of the etiology of adverse reactions through the clarification of definitions, refining of testing and assessment procedures for classifying reactions, and the identification of the populations who are indeed at risk for the numerous types of reactions that may occur. Although the evaluation of adverse reactions is a challenging problem, it is a problem that can be overcome.