Intake of vitamins E, C, and A and risk of lung cancer. The NHANES I epidemiologic followup study. First National Health and Nutrition Examination Survey.

The relation between the dietary intake of vitamins E, C, and A (estimated by a 24-hour recall) and lung cancer incidence was examined in the First National Health and Nutrition Examination Survey Epidemiologic Followup Study cohort of 3,968 men and 6,100 women, aged 25-74 years. During a median follow-up period of 19 years (from 1971-1975 to 1992), 248 persons developed lung cancer. Adjusted for potential confounders using Cox proportional hazards regression methods with age as the underlying time variable, the relative risk of lung cancer for subjects in the highest quartile of vitamin C intake compared with those in the lowest quartile was 0.66 (95% confidence interval (CI) 0.45-0.96). For vitamin A intake, a protective effect was observed only for its fruit and vegetable component (carotenoids) among current smokers (relative risk = 0.49, 95% CI 0.29-0.84), but this was modified by the intensity of smoking (a statistically significant effect (relative risk = 0.33, 95% CI 0.13-0.84) was observed only for those in the lowest tertile of pack-years of smoking). The vitamin E intake-lung cancer relation was modified by the intensity of smoking with a significant protective effect confined to current smokers in the lowest tertile of pack-years of smoking (relative risk = 0.36, 95% CI 0.16-0.83). Overall, there was no additional protective effect of supplements of vitamins E, C, and A beyond that provided through dietary intake. When vitamin E, vitamin C, and carotenoid intakes were examined in combination, a strong protective effect was observed for those in the highest compared with those in the lowest quartile of all three intakes (relative risk = 0.32, 95% CI 0.14-0.74). These data provide support for a protective role of dietary vitamins E and C and of carotenoids against lung cancer risk but with a modification in effects by the intensity of cigarette exposure. While smoking avoidance is the most important behavior to reduce lung cancer risk, the daily consumption of a variety of fruits and vegetables that provides a combination of these nutrients and other potential protective factors may offer the best dietary protection against lung cancer.

An epidemiologic review of dietary intake studies among American Indians and Alaska Natives: implications for heart disease and cancer risk.

PURPOSE: Dietary factors play an important role in the occurrence of heart disease and cancer. While American Indians and Alaska Natives (AIANs) have unique heart disease and cancer mortality profiles, little is known about the effect of diet on heart disease and cancer risk in these populations. This paper reviews existing nutritional intake data from adult AIANs, and considers the potential impact of diet on heart disease and cancer in these communities. METHODS: A review of the literature was conducted using the Medline database system and other reference materials. Studies documenting nutrient intakes only were included in this review. Studies were limited to those among healthy, non-pregnant adults. RESULTS: A total of twelve reports from 1959 to 1996 were found. Sample sizes for the studies ranged from 20 to 575 subjects. Most studies were done among women, and a variety of nutritional assessment techniques (24 hour recall, food frequency questionnaire, multiple-day food record) were used. Most studies also had limited nutrient intake data, especially for dietary fiber and vitamin E. The majority of studies reported moderately high intakes of fat and saturated fat, and low intakes of polyunsaturated fat and fiber. CONCLUSIONS: Based on the limited data, diet may play an important role in the heterogeneity of heart disease and cancer mortality in AIAN communities. More research is needed to assess the impact of diet on heart disease and cancer risk, including more longitudinal data, and data to assess the validity and reliability of traditional methods of dietary assessment.

Diet, indicators of kidney disease, and later mortality among older persons in the NHANES I Epidemiologic Follow-Up Study.

OBJECTIVES: The purpose of this study was to determine whether diet adversely affected survival among 2572 older persons with indicators of kidney disease in a population-based cohort. Average follow-up time for survivors, of whom 1453 (57%) had died at analysis, was 14.5 years. METHODS: Kidney disease indicators were a "yes" response to "Has a doctor ever told you that you have kidney disease or renal stones?" and/or trace or greater amounts of protein in urine. Dietary protein intakes were calculated from 24-hour recalls. RESULTS: Cox proportional hazards models were used, stratified by sex, with age, body mass index, blood pressure, education, smoking status, total caloric intake, and diabetes mellitus as covariates. Relative risk of total mortality with an additional 15 g of protein per day was 1.25 (95% confidence interval [CI] = 1.09, 1.42) among White men with kidney disease indicators, vs 1.00 (95% CI = 0.95, 1.06) among those without them; relative risks of renal-related mortality were 1.32 (95% CI = 0.97, 1.79) and 0.95 (95% CI = 0.81, 1.11), respectively. No significant differences were found for White women. CONCLUSIONS: Once chronic renal disease is present, diet may be associated with earlier mortality in White males.

Dietary patterns of U.S. children: implications for disease prevention.

Nutritional data from the second National Health and Nutrition Examination Survey (NHANES II) were analyzed to assess dietary patterns of a representative sample of U.S. children and youth ages 1-17 years. The data show that the average U.S. child's diet is relatively high in total and saturated fat and low in the ratio of polyunsaturated to saturated fat. These dietary patterns deviate from current dietary recommendations for the prevention of cardiovascular diseases. The percentage contributions of specific macronutrients to total energy intake (in kilocalories) were total fat, 35-36%; total carbohydrates, 49-51%; and protein, 15-16%. This is in contrast to current expert recommendations for children of 30% of kilocalories as total fat, 55% as carbohydrates, and 15% as protein. The observed intake of saturated fat in U.S. children was 13% of kilocalories vs a recommended level of 10% of kilocalories. The observed ratio of polyunsaturated to saturated fat intake was 0.4 vs a recommended ratio of 1.0. There were important racial differences in fat intakes, with blacks generally having higher cholesterol and total fat intakes. White children generally consumed more of their calories as carbohydrates than did black children, but there were no differences in protein intakes between the two groups. In summary, these data suggest that the average U.S. child's diet deviates from recommended dietary guidelines for fat and cholesterol intakes. Black children's dietary patterns appear less favorable for cardiovascular health than those of white children. However, the data also show that achieving recommended dietary intake patterns probably will not require drastic changes in the U.S. child's diet.

A data-based approach to diet questionnaire design and testing.

A self-administered diet history questionnaire has been developed for epidemiologic and clinical use. Both the food list and the nutrient values to be associated with it were developed using dietary data from 11,658 adult respondents to the Second National Health and Nutrition Examination Survey (NHANES II). Food items were selected on the basis of their contribution to total population intake of energy and each of 17 nutrients in the NHANES II data, and represent over 90% of each of those nutrients. Associated nutrient composition values were determined from the NHANES II database using frequency of consumption data in that survey. Portion sizes to be associated with each food item were derived from observed portion size distributions in NHANES II, based on three-dimensional models. The resulting food list and its corresponding brief data base, when used to calculate nutrients from a diet record, yielded correlations of r greater than 0.70 with the more detailed method. Field administration produced mean values comparable to national data.

Nutrient sources in the American diet: quantitative data from the NHANES II survey. I. Vitamins and minerals.

Dietary data from 11,658 adult respondents in the second National Health and Nutrition Examination Survey were used to provide quantitative information regarding the contribution of specific foods to the total population intake of the following 10 nutrients: vitamin A, thiamine, riboflavin, niacin, vitamin C, iron, phosphorus, calcium, sodium, and potassium. Data are reported in the companion paper regarding the number of adults in the US population consuming each of 147 food items, representing all foods reported by these respondents. The percentage of total nutrient intake which each food provides is presented for the top 50 contributors of each of the nutrients listed above. Foods sometimes overlooked as important sources are found in some instances to be quantitatively important to population intake, such as spaghetti dishes as an independent source of carotenoids. These data should be useful to epidemiologists with a substantive interest in dietary etiologies or a methodological interest in the development of dietary assessment instruments. In addition, they may be useful to health care planners or nutrition educators.

Nutrient sources in the American diet: quantitative data from the NHANES II survey. II. Macronutrients and fats.

Dietary data from 11,658 adult respondents in the second National Health and Nutrition Examination Survey were used to provide quantitative information regarding the contribution of specific foods to the total population intake of the following nutrients: calories, protein, carbohydrate, total fat, saturated fat, oleic acid, linoleic acid, and cholesterol. The percentage of total nutrient intake which each food provides is presented for the top 50 contributors of each of these nutrients, as well as the proportion of the population consuming them. These data may provide a basis for the selection of foods to be included in dietary assessment instruments. They may also be useful to health care planners or nutrition educators.