Development and validation of the Cholesterol-Saturated Fat Index (CSI) Scorecard: a dietary self-monitoring tool.

OBJECTIVE: The Cholesterol-Saturated Fat Index (CSI) Scorecard was developed and tested as a self-monitoring tool for patients consuming a cholesterol-lowering diet. SUBJECTS/DESIGN: Twelve nutritionists used the CSI Scorecard to estimate the CSI score of the same five food records. Subsequently, using a revised tool, 12 subjects with hypercholesterolemia estimated the CSI score of their 4-day food records and 11 participated in evaluation meetings. STATISTICAL ANALYSES: Two-tailed, one-sample t tests and the Spearman rho correlation test were used, respectively, to compare CSI Scorecard estimates of nutritionists and participants to CSI scores obtained from computer calculations. RESULTS: The CSI scores estimated by the nutritionists were close to the computed scores at the 25th and 75th food record percentiles. The correlation of the estimated CSI scores of participants to the computed scores was rs = .8 (P < .05). APPLICATION: The CSI Scorecard is a new, simple, quick, and accurate dietary self-monitoring tool patients can use in research centers and primary care settings. By numerically illustrating the saturated fat and cholesterol content of foods, the CSI Scorecard facilitates dietary self-monitoring and, thus, self-efficacy in the adoption and maintenance of a cholesterol-lowering dietary pattern.

Anthropometric measurements of white and black southern adolescent girls.

Anthropometric measurements of 691 white and 550 black 12-, 14-, and 16-year-old girls from three income groups, residing in the southern United States, were evaluated, Heights, weights, mid-upper arm circumferences, and arm muscle areas of 14-year-old girls were significantly higher than those of 12-year-old girls and significantly lower than those of girls 16 years of age; triceps skinfolds, arm fat areas, and body mass indexes of 12-year-olds were significantly lower than those of older subjects. Blacks had significantly higher weights, body mass indexes, and arm muscle areas than whites. Black 12-year-old girls were significantly taller than white 12-year-old girls but significantly shorter than older girls of either race; white 16-year-old girls were significantly taller than blacks of that age. Body mass indexes of black 12-year-olds and white 14-year-olds were significantly higher than those of white 12-year-olds, and significantly lower than those of black 14- and 16-year-olds. Medium-income blacks and whites of all income levels had lower (usually significantly) weights, body mass indexes, mid-upper arm circumferences, arm muscle areas, and arm fat areas than low- and high-income blacks did. Anthropometric values of white, but not of black, girls were generally similar to those reported in surveys of primarily white girls.

Self-esteem of adolescent girls as related to weight.

The Rosenberg Self-esteem Scale was administered to 550 14- and 16-yr.-old (+/- 6 mo.) girls. Self-esteem scores were categorized by weight and weight by height. Scores on the Quetelet Index for obesity were correlated with self-esteem scores. Mean self-esteem of the low- and middle-weight by height group was significantly higher than the mean of the high-weight by height group. In analyzing weight alone, the self-esteem of the middle-weight group was significantly higher than the self-esteem of the high-weight group. The correlation of the obesity index and self-esteem indicated that as weight increased self-esteem decreased.

Nutrients supplied by food groups in diets of teenaged girls.

Sources of nutrients were determined in diets of teenaged girls, a group generally thought to be at nutritional risk. This study of Southern adolescent girls of two races examines intakes of energy, energy-yielding nutrients, vitamins, minerals, and other components of various food groups. Effects of race, age, place of residence, and per capita income on nutrients furnished by food groups were determined from two 24-hour dietary recalls from each of 1,195 girls, aged 12, 14, or 16. Of the food groups examined, foods of low nutrient density provided the most energy, fat, and carbohydrate. The meat group provided the most protein. Dairy products, which supplied the largest amounts of six vitamins and minerals of any food group, were used less by black, rural, or older teenagers than by white, urban, or younger girls. Blacks obtained more vitamin A from vegetables and more thiamin from meat than whites. Amounts of meat, starchy, and low-nutrient-density subgroups also varied with race, age, and/or place of residence. As income increased, consumption of starches (especially breakfast cereals) and eggs decreased and that of fruit increased.

Factors related to blood pressure in a biracial adolescent female population.

Blood pressure levels, anthropometric parameters, and dietary intakes were assessed in 1981 and 1983 in a population of black (n = 236) and white (n = 296) adolescent girls, aged 14 and 16 years in 1983. The 14-year-old black girls exhibited significantly higher mean systolic and diastolic blood pressures than whites in both years. Body weight and Quetelet index were more strongly associated with blood pressure than were height and triceps skinfold thickness. Correcting blood pressures for weight, Quetelet index, 2-year changes in height, and age at menarche decreased in each case (but did not negate) the observed race differences in blood pressure. Dietary calcium and potassium intakes were inversely related to blood pressure, and a race difference in the intake of these nutrients (whites greater than blacks) was observed. Covariate adjustment for calcium, but not for potassium, decreased the magnitude of race differences in blood pressure. Family type (single-parent vs nuclear) and place of residence (urban vs nonurban) appeared to be the most important confounding variables for race differences in blood pressure, since differences largely were eliminated by controlling for these factors. Conflicting reports in the literature regarding the age range during which race differences in blood pressure become apparent may be partially attributed to the complex interrelationships among these factors and the potential influence of other genetic-environmental interactions that may also play a role in blood pressure regulation.

Nutrient intakes of female adolescents from eight southern states.

Nutrient intakes were calculated from two 24-hour recalls for 1,247 adolescent black and white girls. Whites consumed more vitamins E, C, and B-12, niacin, folacin, calcium, phosphorus, magnesium, and zinc and had higher intakes per 1,000 kcal of those nutrients, protein, vitamin D, and iron than blacks. Intakes of calcium (whites) and magnesium (both races) decreased with age. Urban girls consumed more energy and magnesium than rural ones. Folacin intake increased with income. Folacin intakes were most frequently below 67% RDAs, followed by intakes of iodine, vitamin D, iron, calcium, vitamin B-6, zinc, magnesium, and vitamin A. The majority of diets met or exceeded RDAs for protein, vitamins E, C, and B-12, riboflavin, and thiamin. Intakes are reported for most nutrients for which safe ranges have been set.

Zinc retention and losses of zinc in sweat by preadolescent girls.

Preadolescent girls, ages 7 to 9 years, were fed levels of zinc ranging from 5.61 to 14.61 mg/day during an 18-day metabolic study. All other nutrients were provided at or above Recommended Dietary Allowance levels. The sweat loss of zinc was measured using an arm-bag method and whole body zinc loss was calculated from whole body nitrogen and arm loss of nitrogen and zinc. Fecal zinc reflected dietary zinc, but urinary zinc remained relatively stable. The mean daily loss of zinc through sweat was calculated to be 1.43 mg. Zinc retentions were not significantly different (P greater than 0.05) though the retention increased generally with intake of zinc. A comparison of these data with previously reported studies indicated that the absorption of zinc was usually in the range of 20 to 30%. Based on sweat losses reported by others and found in this study and on usual absorption of zinc, it appears that diets should provide a minimum of 7 mg of zinc daily for growing children.

The relationship of zinc to protein utilization in the preadolescent child.

The effects of zinc intake on nitrogen utilization was investigated during a 20-day balance study with 23 preadolescent girls. The children were fed a diet which provided 4.17 g of nitrogen and 5.5 mg of zinc daily; the diet was supplemented with a combination of 5 mg of zinc and/or nitrogen supplied from either amino acids or nonspecific nitrogen. Complete collections of excreta were made throughout the study. Neither the supplementation of amino acids nor zinc improved the retention of nitrogen. Urinary excretion of urea nitrogen, uric acid, and creatinine were not different as a result of zinc supplementation. Subjects consuming the lower level of zinc were in negative zinc balance, but the subjects consuming 10.5 mg of zinc were in positive balance. The supplementation of this low protein diet with amino acids did not improve nitrogen retention.

Protein nutrition value of urea supplementation of opaque-2 corn for adolescent boys.

The effect of urea supplementation on the protein nutritional value of a plant protein, opaque-2 corn, for adolescent boys was investigated. Seven 12- to 16-year-old boys were subjects for this 23-day study. The mean apparent nitrogen balance when 6 g of nitrogen from corn was fed and when 4 g of nitrogen from urea was added were + 0.63 and + 1.37 g/day, respectively. The improvement in nitrogen balance resulting from the addition of urea to a plant protein source suggested that urea may be used to partially supply the protein needs of growing boys.

An estimation of mineral losses through arm sweat of preadolescent children.

Balance studies were conducted to determine the effects of three levels of nitrogen intake on the loss of nitrogen through sweat in preadolescent boys and girls. During the studies, the losses of calcium, iron, magnesium, manganese, potassium, sodium, and zinc were determined in the arm sweat of the subjects. Sweat from the forearm was collected in a polyethylene bag for 1 hr on three different occasions. Using the concentrations of nitrogen in the arm bag and in the whole body collection and the concentration of minerals in the arm bag, the total body loss of minerals were estimated. Losses of minerals through sweat, expressed as a percentage of intake, ranged from 0.12 to 1.10%. Under conditions of these studies, sweat losses of the essential minerals were not a significant factor in estimating total losses.

The effects of sweat nitrogen losses in evaluating protein utilization by preadolescent children.

A nitrogen balance study was conducted to determine the effects of three levels of nitrogen intake on the loss of nitrogen through sweat and to assess further the impact of sweat nitrogen on protein needs of preadolescent children. Values were determined through the collection of 24-hr, total body sweat samples from twelve healthy boys having a mean age of 8 years, 8 months. Mean height and weight of the subjects were 131.4 cm and 31.0 kg, respectively. Environmental conditions were relatively constant during the study. Mean sweat nitrogen losses were 208, 287, and 368 mg/day on daily protein intakes of 29, 54, and 84 g, respectively. Mean nitrogen balances per day were 0.39, 0.09, and 1.95 g when sweat nitrogen losses were included in the calculations. At the lower and moderate levels of protein intake, nine and six subjects were in negative nitrogen balance when sweat losses were considered. Sweat nitrogen losses in the boys were similar to a previous study with preadolescent girls. Based upon published basal metabolic rates and mean sweat nitrogen losses of 261 and 288 mg/day for girls and boys, the nitrogen lost through sweat was 0.25 mg/basal kcal for both sexes. An estimation of 0.5 mg/basal kcal for integumental nitrogen loss appears realistic for this age group.

Sweat nitrogen losses by and nitrogen balance of preadolescent girls consuming three levels of dietary protein.

A nitrogen balance study was undertaken to determine the effects of three levels of nitrogen intake on the loss of nitrogen through sweat and to assess the impact of sweat nitrogen on the protein needs of preadolescent girls. Values were determined through the collection of 24-hour, total body sweat samples from 15 healthy girls with a mean age of 8 years, 7 months. Mean height and weight of the subjects were 132 cm and 28.9 kg, respectively. Mean sweat nitrogen losses, collected under uncontrolled environmental conditions, were 201 mg, 263 mg and 319 mg/day on 34 g, 57 g and 88 g of protein intake. The environmental conditions throughout the study remained fairly constant. Mean nitrogen balances per day were 0.04 g, 0.55 g and 1.42 g on the respective levels of nitrogen intake, with the inclusion of sweat nitrogen loss, however, a negative nitrogen balance per day was found in 8 and 2 subjects on 34 g and 57 g protein intake. After considering nitrogen retention of 0.3 g which has been recommended by NRC for the minimum nitrogen allowance for growth of preadolescent children, protein intakes higher than that recommended by the NRC-RDA for preadolescent girls may be required for support of normal growth.