A DASH dietary pattern and the risk of colorectal cancer in Canadian adults.

INTRODUCTION: Colorectal cancer (CRC) is a high incidence cancer affecting many Canadian adults each year. Diet is important in the etiology of CRC with many dietary components identified as potential risk factors. The Dietary Approaches to Stop Hypertension (DASH) diet is a well-established pattern to characterize overall eating. The purpose of this study was to characterize a DASH pattern within the Canadian context and to assess its relationship to the risk of CRC in Canadian adults. METHODS: Unconditional multiple logistic regression with control for confounding variables was performed using data from the National Enhanced Cancer Surveillance Study. Dietary intake was captured for this case-control study through a food frequency questionnaire (FFQ) and categorized into a DASH score ranging from 0 to 10 representing a poor to a strong DASH pattern respectively. RESULTS: Consuming a strong DASH pattern of eating (score ≥ 8) was not common in the 3161 cases and 3097 controls. Overall, only 10.8% of men and 13.6% of women had a strong DASH pattern. Multivariate analysis demonstrated a trend for decreasing risk of CRC in men with increasing DASH scores (p value for trend = .007). Men with a strong DASH score had a 33% reduction in risk of CRC compared to those with a low DASH score. There were no significant trends for women for CRC or for colon or rectal cancers separately. CONCLUSION: Our findings are similar to other researchers suggesting a benefit with a strong DASH pattern associated with a decreased risk of CRC, especially in men. Research should further investigate our gender-based differences.

TITRE: Régime DASH et risque de cancer colorectal chez les adultes canadiens. INTRODUCTION: Le cancer colorectal (CCR) est un cancer à taux d'incidence élevé qui touche de nombreux adultes canadiens chaque année. L'alimentation joue un rôle important dans l'étiologie du CCR et de nombreuses composantes alimentaires sont considérées comme des facteurs de risque potentiels. L'utilisation du profil DASH (Dietary Approaches to Stop Hypertension, régime alimentaire qui vise à lutter contre l'hypertension) est un moyen efficace de caractériser l'alimentation générale des individus. L'objectif de cette étude a été de déterminer un profil DASH en contexte canadien et de vérifier ses liens avec le risque de CCR chez les adultes canadiens. MÉTHODOLOGIE: Nous avons effectué une régression logistique multiple inconditionnelle avec contrôle des variables de confusion en utilisant des données de l'étude nationale de surveillance accrue du cancer. Dans cette étude cas-témoins, l'information sur l'alimentation a été recueillie au moyen d'un questionnaire de fréquence de consommation des aliments (QFCA) et un score de 0 à 10 correspondant au profil DASH a été attribué, le score de 0 représentant le profil DASH le plus faible et le score de 10, le profil DASH le plus fort. RÉSULTATS: Les profils DASH forts (score de 8 ou plus) n'étaient pas fréquents parmi les 3 161 cas et les 3 097 témoins : dans l'ensemble, seuls 10,8 % des hommes et 13,6 % des femmes avaient un profil DASH fort. L'analyse multivariée a révélé une tendance à la baisse du risque de CCR chez les hommes avec l'augmentation du score DASH (valeur p de la tendance : 0,007) : chez les hommes à score DASH élevé, le risque de CCR était de 33 % moindre que chez les hommes à score DASH faible. Chez les femmes, il n'y avait aucune tendance statistiquement significative en ce qui concerne le risque de CCR, ou le risque de cancer du côlon ou de cancer du rectum séparément. CONCLUSION: Nos résultats sont similaires à ceux d'autres chercheurs et laissent entendre qu'un profil DASH fort aurait un effet bénéfique associé à une diminution du risque de CCR, en particulier chez les hommes. Des travaux de recherche ultérieurs devraient viser à élucider les différences que nous avons observées entre les sexes.

25-Hydroxyvitamin D in Canadian adults: biological, environmental, and behavioral correlates.

SUMMARY: We assessed vitamin D status and its correlates in the population-based Canadian Multicentre Osteoporosis Study (CaMos). Results showed that serum 25-hydroxyvitamin D levels <75 nmol/L were common. Given Canada's high latitude, attention should be given to strategies for enhancing vitamin D status in the population. INTRODUCTION: Inadequate vitamin D has been implicated as a risk factor for several clinical disorders. We assessed, in a Canadian cohort, vitamin D status and its correlates, based on serum 25-hydroxyvitamin D [25(OH)D], the best functional indicator of vitamin D status. METHODS: We studied 577 men and 1,335 women 35+ years from seven cities across Canada in the randomly selected, population-based Canadian Multicentre Osteoporosis Study (CaMos). Participants completed a comprehensive questionnaire. Serum 25(OH)D was measured by immunoassay. Multivariate linear regression modeling assessed the association between 25(OH)D and determinants of vitamin D status. RESULTS: Participants (2.3%) were deficient in 25(OH)D (<27.5 nmol/L); a further 18.1% exhibited 25(OH)D insufficiency (27.5-50 nmol/L). Levels <75 nmol/L were evident in 57.5% of men and 60.7% of women and rose to 73.5% in spring (men) and 77.5% in winter (women); 25(OH)D <50 nmol/L was ≤10% year round for those supplementing with ≥400 IU vitamin D/day but was 43.9% among those not supplementing in winter and spring. The strongest predictors of reduced 25(OH)D for both men and women were winter and spring season, BMI ≥30, non-white ethnicity, and lower vitamin D supplementation and its modification by fall and winter. CONCLUSIONS: In this national Canadian cohort, vitamin D levels <75 nmol/L were common, particularly among non-white and obese individuals, and in winter and spring. Vitamin D intake through diet and supplementation and maintenance of normal weight are key modifiable factors for enhancing vitamin D status and thus potentially influencing susceptibility to common chronic diseases.

Attitudes and health behaviours of young adolescent omnivores and vegetarians: a school-based study.

This study aimed to identify attitudes, health behaviours, social adjustment and self-reported health of vegetarian and omnivore teenagers and determine characteristics independently related to vegetarian status. Participants were 630 Grade 9 students, ages 13-15 years, in seven schools in Ontario, Canada. Vegetarian status was determined using a 19-item food inventory. The vegetarian group included lacto, ovo and/or lacto-ovo and semi-vegetarians. Omnivores consumed red meat at least monthly. Social adjustment factors included school misbehaviour, low academic performance, authority-defying risks and unsafe/illegal risks. Logistic regression estimated the relationship of characteristics to vegetarian status. The sample comprised 25 vegetarians (4%) and 605 omnivores. Analyses focussed mainly on females; 22 vegetarians and 315 omnivores. Dieting behaviours (current, frequent and past year), alcohol use, poorer social adjustment and poorer self-rated health were positively related to vegetarian eating (p<.05). Among females (using logistic regression), past year dieting (OR 9.88; 95% CI 2.19-44.47) and alcohol use (OR 2.91; 95% CI 1.02-8.32) predominated in the presence of attitudes that personal health and animal rights are very important. The model predicted 79.9% of cases. Teenage vegetarians were distinctive in health behaviours. The independent, positive association of alcohol use with vegetarian eating is a unique and concerning finding. Dieting behaviours were strongly, independently and positively linked to female vegetarian eating. Further studies with a greater range of behaviours would be useful to more fully characterize teenage vegetarians and explore subgroups.

Energy and protein intakes of acute stroke patients.

BACKGROUND: Although protein-energy malnutrition has been cited as a frequent complication following stroke, there is very little data describing nutritional intake among hospitalized patients. OBJECTIVE: To report: i) the level of protein and energy intake, ii) the adequacy of intake during the first 21 days of hospitalization and iii) to examine the differences in nutritional intake associated with diet type (regular texture, texture-modified and enteral feeding). DESIGN: Prospective observational study of an inception cohort. The energy and protein intakes of well-nourished patients with recent onset of first time stroke were assessed at admission to hospital and at days 7, 11, 14 and 21. Adequacy of energy intake at each of these intervals was expressed as a percentage (actual intake/energy requirement assessed by indirect calorimetry x 100). Adequacy of protein intake was assessed in a similar manner, with 1 g/kg of actual or adjusted body weight used to estimate requirement. The nutritional intakes of patients receiving regular diets, dysphagia diets and enteral tube feedings were compared using one-way ANOVA. RESULTS: The average energy intakes of the entire study group ranged from 19.4-22.3 Kcals/kg/day over five observation points, representing 80.3-90.9% of measured requirements; protein intake and ranged from 0.81-0.90 g/kg day yielding adequacy of intake of 81-90% of requirement. There were significant differences in energy intakes and/or adequacy of intake of patients receiving different diet types at days 11, 14 and 21 (p < 0.05) and differences in protein intake and/or adequacy of protein intake at all intervals except admission (p < 0.05). Patients receiving enteral tube feedings consumed more calories and protein compared to those patients on regular or dysphagia diets. CONCLUSIONS: On average, newly diagnosed, well-nourished, hospitalized patients consumed 80-91% of their both their energy and protein requirements, in the early post stroke period.

Quantifying fluid intake in dysphagic stroke patients: a preliminary comparison of oral and nonoral strategies.

OBJECTIVE: To determine whether dysphagic stroke patients receiving oral (thickened-fluid dysphagia) diets or nonoral (enteral feedings supplemented with intravenous fluids) diets met their estimated fluid requirements. DESIGN: Cohort study. SETTING: University-affiliated hospital. PARTICIPANTS: Thirteen dysphagic patients with new strokes were studied for 21 days postadmission to hospital. INTERVENTIONS: Seven patients (group 1) were started on nonoral feeding and later progressed to oral diets and 6 patients (group 2) received oral dysphagia diets only. MAIN OUTCOME MEASURE: Fluid intake. RESULTS: Fluid intake of patients in group 1 significantly declined over the 21 days (mean +/- standard deviation, 3158 +/- 523mL/d vs 984 +/- 486mL/d; p < .0001), representing 134% +/- 26% and 43% +/- 20% of their fluid requirements, respectively. Mean fluid intake of patients in group 2 was 755 +/- 162mL/d, representing 33% +/- 5% of requirements. This volume was significantly lower than the fluid intake of patients who received nonoral feeding (p < .0001). CONCLUSIONS: Dysphagic stroke patients who received thickened-fluid dysphagia diets failed to meet their fluid requirements whereas patients on enteral feeding and intravenous fluid regimens received ample fluid.

Sudden death in the dysphagic stroke patient--a case of airway obstruction caused by a food bolus: a brief report.

The clinical events leading up to the sudden death of a dysphagic stroke patient with dementia is described. A 63-yr-old man sustained right thalamic and mid-brain infarctions. On the inpatient stroke rehabilitation ward, he exhibited significant impulsivity and dementia, the latter felt to be premorbid. The patient frequently coughed, and modified barium swallow testing showed dysphagia, with aspiration occurring only when consuming greater than teaspoon amounts of liquid. He subsequently died at home while eating a meal. Autopsy showed an intact large cheese ball (bocconcini) occluding the airway. Sudden death in the impulsive stroke patient secondary to airway occlusion by a food bolus has not previously been reported, although such patients seem to be at greater risk. New eating-related interventions are warranted for dysphagic patients who exhibit impulsivity. It is proposed that food particle size be limited to 1 cm2 and that such patients be closely monitored while eating.

Prolonged length of stay and reduced functional improvement rate in malnourished stroke rehabilitation patients.

OBJECTIVE: To determine associations between the nutritional status of inpatient rehabilitation (rehab) unit stroke patients and (1) length of stay (LOS) and (2) functional outcome using Modified Barthel Index (MBI). Secondary objective-to determine whether hypoalbuminemia was equally related to outcome measures. A priori hypothesis-LOS and MRI are adversely related to malnutrition. DESIGN: inception cohort study. SETTING: Tertiary care center. PATIENTS: 49 consecutive "middle-band" patients (4 declined). MAIN OUTCOME MEASURES: LOS and MRI at admission (T1), 1 month (T2), and discharge (T3). RESULTS: LOS was significantly related to overall malnutrition, T1 and T2MBI scores, T1 dysphagia, T1 enteral feeding (all p<.01), T1 malnutrition, peripheral vascular disease (negative relationship), and diabetes mellitus history (all p<.05). In analysis of covariance, adjusting for T1 MBI, overall rehab malnutrition was related to LOS (p=.011). Other covariates were not significant. T1 malnutrition was related to lower T2 MBI scores(p=.038). Lower T1 MBI scores was related to T2 malnutrition (p=.032). Diabetics (p=.005) and right hemispheric lesion patients(p=.015) had lower T1 MBI scores. Hypoalbuminemia was unrelated to LOS and MBI scores. Although malnourished and adequately nourished functionally dependent patients improved equally in MBI scores by discharge, prolonged LOS in the malnourished lowered their functional improvement rate ([T3 MBI - T1 MBI]/LOS) (p=.047). CONCLUSIONS: Malnutrition was the most potentially modifiable variable relating to LOS and functional outcome. Close attention to nutrition status may help to optimize stroke patients' rehab potential and use of health care resources.

Malnutrition in stroke patients on the rehabilitation service and at follow-up: prevalence and predictors.

This prospective study presents the prevalence and risk factors of malnutrition in 49 consecutive stroke patients on the rehabilitation (Rehab) service and at 2- to 4-month follow-up. Malnutrition was diagnosed using biochemical and anthropometric data. Stroke patients, on admission to Rehab, have a very high prevalence of malnutrition. Malnutrition, 49% on admission, declined to 34%, 22%, and 19% at 1 month, 2 months, and follow-up, respectively. Dysphagia, 47% on admission, was associated with malnutrition (p = .032) and significantly declined over time. Using logistic regression, predictors of malnutrition on admission involved acute service tube feedings (p = .002) and histories of diabetes (p = .027) and prior stroke (p = .013). Tube feedings, associated with malnutrition on admission (p = .043), were more prevalent in brain stem lesion patients. Patients tube fed > or = 1 month during rehabilitation or at home were not malnourished. Malnutrition was associated with advanced (> 70 years) age at 1 month (p = .002) and weight loss (p = .011) and lack of community care (p = .006) at follow-up. Early and ongoing detection and treatment of malnutrition are recommended during rehabilitation of stroke patients both on the service and at follow-up.

Infant feeding practices and socio-demographic factors in Ottawa-Carleton.

Parents of 320 infants 6-18 months of age were interviewed to determine infant feeding practices and socio-demographic factors contributing to parental choices. 76% of women breastfed initially. Social class was directly related to the incidence of breastfeeding. 50% of the women who started breastfeeding continued to do so at 6 months, a figure which is higher than that previously reported in Canada. Although social class was a major determinant in parents' choice of infant feeding, cultural factors were also very important. A higher proportion of mothers who spoke languages other than English or French in the home (including mainly Polish, Italian, Spanish, and East Indian) breastfed their infants than did mothers who spoke French, even though more of them were in the lowest socio-economic group. The reason for the relatively low incidence of breastfeeding by Francophone mothers is unclear.