Validation of the Arizona Activity Frequency Questionnaire using doubly labeled water.

PURPOSE: Physical activity questionnaires (PAQs) are considered the most cost-efficient method to estimate total energy expenditure (TEE) in epidemiological studies. However, relatively few PAQs have been validated using doubly labeled water (DLW) in women or in samples with diverse ethnic backgrounds. This study was conducted to validate the Arizona Activity Frequency Questionnaire (AAFQ) for estimation of TEE and physical activity energy expenditure (PAEE) over 1 month using DLW as a reference method. METHODS: Thirty-five relatively sedentary women completed the AAFQ before participating in an 8-d DLW protocol to measure TEE. TEE and PAEE were estimated from the AAFQ by calculating resting metabolic rate (RMR) using the equation of Mifflin et al. (AAFQmif), by measuring RMR using indirect calorimetry (AAFQic), and using MET conversion (AAFQmet). A predictive equation for TEE was generated. RESULTS: The mean +/- SD for TEE and PAEE from DLW were 9847 +/- 2555 kJ x d(-1) and 5578 +/- 2084 kJ x d(-1), respectively. Formulas using RMR to calculate the TEE and PAEE from the AAFQ tended to underestimate TEE and PAEE, whereas those that included only weight tended to overestimate TEE and PAEE. On the basis of the Mifflin et al. equation, the AAFQ tends to underestimate PAEE by 13%. This underestimation may be explained by the low lean body mass of the sample population and by effectiveness of the METs/RMR ratio in the obese. The following predictive equation was calculated: TEE (kJ x d(-1)) = (86.0 * average total daily METs) + (2.23 * RMRmif) - 6726. When the predictive equation is used, TEE calculated from the AAFQ is highly correlated with DLW TEE (adjusted r(2) = 0.70, P < 0.001). CONCLUSION: The AAFQ is an effective tool for the prediction of TEE and PAEE in epidemiological studies.

Effect of an integrated nutrition curriculum on medical education, student clinical performance, and student perception of medical-nutrition training.

BACKGROUND: Ninety-eight percent of medical schools report nutrition as a component of medical education. However, most schools do not have an identifiable nutrition curriculum. Medical schools that do include nutrition have not evaluated its effect on clinical skills. OBJECTIVE: The objective was to determine the efficacy of an integrated undergraduate medical curriculum to increase the quantity of nutrition instruction and to advance nutrition clinical skills demonstrated by medical students. DESIGN: A quasiexperimental design was constructed to determine whether an integrated nutrition curriculum increased the performance on nutrition-oriented clinical examinations of medical school classes that received 1, 2, or 3 y of the curriculum. The evaluation of the curriculum focused on 3 areas: 1) hours of nutrition instruction, 2) the application of nutrition within a clinical setting, and 3) perceptions about the nutrition curriculum. The Objective Structured Clinical Examination (OSCE) nutrition score was compared between graduating classes by use of analysis of variance. Data from the American Association of Medical Colleges were analyzed to determine the change in the proportion of students who reported that the amount of time devoted to nutrition was adequate. RESULTS: The implementation of the integrated nutrition curriculum resulted in a doubling of the total hours of required instruction in the medical curriculum (35 compared with 75 h). The mean (+/-1 SEM) OSCE nutrition score significantly improved after the implementation of the curriculum (41.7 +/- 0.9% compared with 50.6 +/- 1.1%) and the percentage of students who reported that the amount of nutrition taught during medical school was inadequate decreased (68.4% compared with 11.5%). CONCLUSION: Medical students improved their clinical nutrition practice skills through participation in an integrated nutrition curriculum.

Red palm oil in the maternal diet increases provitamin A carotenoids in breastmilk and serum of the mother-infant dyad.

BACKGROUND: Despite vitamin A supplementation programs, vitamin A deficiency in children remains a public health concern in Honduras. AIM OF THE STUDY: We investigated the effectiveness of short-term dietary supplementation of mothers with red palm oil as a strategy for improving the vitamin A status of the mother-infant dyad. METHODS: Lactating mothers in Colonia Los Pinos, a barrio of Tegucigalpa, Honduras, consumed a total of 90-mg beta-carotene as red palm oil (n = 32) supplements (n = 36) or placebo (n = 18) in six equal doses over 10 days. Carotenoids and retinol in maternal and infant serum, and breastmilk carotenoids and retinol were measured before and after supplementation. Maternal diet was evaluated by 24-hour recall. RESULTS: Maternal serum alpha-carotene and beta-carotene concentrations were increased 2 fold by palm oil compared with 1.2 fold by beta-carotene supplements. Changes were significantly different in infant serum alpha-carotene but not beta-carotene among the three experimental groups. Increases in breastmilk beta-carotene were greater for the palm oil group (2.5 fold) than for the beta-carotene supplement group (1.6 fold) and increases in milk alpha-carotene concentrations (3.2 fold) were slightly greater than those of beta-carotene. There were also small but significant changes among groups in breastmilk lutein and lycopene. Breastmilk retinol was not significantly different among the groups over the treatment period. CONCLUSIONS: Red palm oil in the maternal diet increases provitamin A carotenoids in breastmilk and serum of the mother-infant dyad. The use of dietary red palm oil to improve the vitamin A status of this population should be further investigated.

Efficacy of transdermal nicotine in reducing post-cessation weight gain in a Hispanic sample.

This study examined nicotine replacement effects and pre-quit smoking characteristics with respect to post-cessation weight gain in a primarily Mexican-American sample of Hispanic smokers. Hispanic smokers (108) were randomly assigned to receive either nicotine transdermal patch or placebo patch for 10 weeks, during which time smoking status and weight change were measured. The overall weight gain experienced by the successful quitters was greater than that experienced by non-quitters. Differences between quitters and non-quitters were significant for both females (2.0 vs. 0.86 kg; p < 0.05) and for males (2.3 vs. 1.2 kg; p < 0.05) at 6 weeks post-randomization. At the end of the 10-week treatment, only the females showed a significant difference in weight gain between the quitters and non-quitters (2.8 vs. 1.1; p < 0.01). Results of the random effects regression models for quitters indicated that the active group gained weight at a significantly lower rate than the placebo group (p = 0.047) for females, but not for males (p = 0.87). Years of smoking (p = 0.001) but not baseline cigarettes (p = 0.13) were significant predictors of weight for females, but not for males (p = 0.24 and 0.72, respectively). The use of nicotine patch treatment for smoking cessation effectively attenuated weight gain for successful female quitters compared with placebo-treated quitters. Identification of pre-quit smoking characteristics may prove useful in predicting who is most likely to gain weight when quitting smoking.

A qualitative study of participants' experiences with dietary assessment.

OBJECTIVE: This article reports on the use of focus groups and an experimental participatory activity to investigate factors influencing participants' decisions about what to eat and what to report on food records and food frequency questionnaires. DESIGN: Four focus groups examined participants' experience with diet records and 3 focus groups explored the topic of food portions using a group consensus activity. Twenty-two women participated in the diet record focus groups, and 15 participated in portion estimation groups. SUBJECTS: Focus group participants were equally distributed by age and body mass index values. Each woman completed a 10-day doubly labeled water protocol to measure total energy expenditure, 7 days of diet records (before and during total energy expenditure), and a food frequency questionnaire after the total energy expenditure. ANALYSIS: Transcripts of the focus groups were coded to index categories of responses and to identify themes within and across those responses. Themes discussed in this article are those that were discussed most often and at greatest length by all groups. RESULTS: The diet record focus groups revealed that 2 major factors influenced reporting on diet records: honesty vs social acceptability, and simplifying food intake. The portion estimation focus groups revealed 5 factors that influenced perceptions of portion size: the role of food in the meal, the type of food, personal preferences, product serving sizes, and comparison of personal servings with those of others. APPLICATIONS: The validity and reliability of self-reported food consumption is greatly influenced by the ways people interpret and respond to dietary assessment instruments. These findings indicate that dietetics professionals need to take extra steps to address issues of accurately recording "bad" foods when training patients to complete diet records. Extra probing is needed when dietary records do not include snacks and include simple meals and a large amount of prepared and packaged food because this may indicate that changes in normal dietary patterns were made in order to more easily complete a dietary record.

Dieting, essential fatty acid intake, and depression.

Studies have both supported and contested the proposition that lowering plasma cholesterol by diet and medications contributes to depression. Evidence suggests that an imbalance in the ratio of the essential fatty acids (EFAs), namely the n-6 and n-3 fatty acids, and/or a deficiency in n-3 fatty acids, may be responsible for the heightened depressive symptoms associated with low plasma cholesterol. These relationships may explain the inconsistent findings in trials of cholesterol-lowering interventions and depression. Dieting behaviors have similarly been associated with alterations in mood state. This review discusses studies of EFAs and depression and explores the involvement of dieting-related psychological factors as potential confounders.

Chocolate: food or drug?

Although addictive behavior is generally associated with drug and alcohol abuse or compulsive sexual activity, chocolate may evoke similar psychopharmacologic and behavioral reactions in susceptible persons. A review of the literature on chocolate cravings indicates that the hedonic appeal of chocolate (fat, sugar, texture, and aroma) is likely to be a predominant factor in such cravings. Other characteristics of chocolate, however, may be equally as important contributors to the phenomena of chocolate cravings. Chocolate may be used by some as a form of self-medication for dietary deficiencies (eg, magnesium) or to balance low levels of neurotransmitters involved in the regulation of mood, food intake, and compulsive behaviors (eg, serotonin and dopamine). Chocolate cravings are often episodic and fluctuate with hormonal changes just before and during the menses, which suggests a hormonal link and confirms the assumed gender-specific nature of chocolate cravings. Chocolate contains several biologically active constituents (methylxanthines, biogenic amines, and cannabinoid-like fatty acids), all of which potentially cause abnormal behaviors and psychological sensations that parallel those of other addictive substances. Most likely, a combination of chocolate's sensory characteristics, nutrient composition, and psychoactive ingredients, compounded with monthly hormonal fluctuations and mood swings among women, will ultimately form the model of chocolate cravings. Dietetics professionals must be aware that chocolate cravings are real. The psychopharmacologic and chemosensory effects of chocolate must be considered when formulating recommendations for overall healthful eating and for treatment of nutritionally related health issues.

The association of energy intake bias with psychological scores of women.

OBJECTIVE: Assess the association between reporting bias of dietary energy intake and the behavioral and psychological profiles in women. DESIGN: At baseline a series of questionnaires were administered to 37 women, (the Marlowe-Crowne Social Desirability Scale, Weinberger Adjustment Inventory (WAI), the Eating Disorder Inventory (EDI), the Restraint Scale and Sorensen-Stunkard's silhouettes). Subjects received training on how to record dietary records. Subjects recorded three days of dietary records to measure energy intake (EI) during a study to determine total energy expenditure (TEE) using doubly labeled water. Reporting accuracy (RA = EI/TEE x 100) was determined for each subject. Statistical analysis of the data used a mixed effects model accounting for within subject variability to determine if the psychological scores were associated with reporting accuracy. SETTING AND SUBJECT: Women were recruited with local advertisements in Tucson, Arizona. The women had a mean ( +/- 1 s.d.) age of 43.6 +/- 9.3 yrs, body mass index (BMI) of 28.7 +/- 8.5 kg/m2 and total body fat (%TBF) of 31.9 +/- 7.3%. RESULTS: Age and %TBF were significantly and inversely associated with RA. Furthermore, Social Desirability was negatively associated with RA. Body dissatisfaction and associating a smaller body size than one's own as being more healthy were also associated with a lower RA. CONCLUSIONS: These results suggest that Social Desirability and self image of body shape are associated with RA. Modifications in subject training may reduce the effect of these factors on RA.

Short-term beta-carotene supplementation of lactating mothers consuming diets low in vitamin A.

We have previously shown that beta-carotene supplementation of the diets of healthy U.S. mothers increases serum and milk beta-carotene concentrations. Building on these results, we investigated the possibility that beta-carotene supplementation could enhance the vitamin A status of mothers and their nursing infants. Three 30-mg doses of beta-carotene were administered on 3 consecutive days to 44 lactating mothers who had vitamin-A-poor diets. Concentrations of maternal serum and milk carotenoids and retinol were evaluated at baseline and after 2 and 3 days of supplementation. Infant serum carotenoids and retinol were measured at baseline and 2 days following maternal supplementation. beta-Carotene supplementation markedly elevated maternal serum and milk beta-carotene concentrations (nine- and sevenfold, respectively) and resulted in smaller, transient increases of alpha-carotene, lycopene, and beta-cryptoxanthin concentrations in maternal serum. Maternal serum and milk retinol were unchanged in response to the treatment. In contrast, maternal beta-carotene supplementation significantly increased infant serum retinol (P

The nutritional status of Guaymi Indians living in Chiriqui province, Republic of Panamá.

Guaymi Indian children have recently been identified as a population group who are at risk for vitamin A deficiency with numerous cases of xerophthalmia with ocular perforation being reported. A four-day parasitological and nutritional clinic based survey was conducted with 335 Guaymi women and children in the towns of San Felix and Alto Caballero to identify the prevalence of parasitic infections and factors associated with malnutrition. A subsample of 79 children, under 19 years of age, from independent families was constructed for the current analysis. The results of the study indicated that 20% of the children had a plasma vitamin A concentration less than 20 micrograms/dl. Significant associations were identified between ascariasis, age, a food diversity score and vitamin A concentrations. Other indicators of nutritional status were also negatively associated with intestinal parasitic infections, and a modernization index, using multivariate regression analysis. In conclusion, this study identified several factors associated with poor nutritional status that can be used by health officers to identify Guaymi children at risk for malnutrition.

The association of prenatal nutrition and educational services with low birth weight rates in a Florida program.

Nutrition services and education, provided as components of normal prenatal care, have a key role in preventing preterm delivery and low birth weight (LBW). To determine the influence of these components on a woman's risk of having a LBW infant, the authors examined groups of patients who were receiving the services. Bivariate analyses were made of 9,024 prenatal charts of single births. Most women received nutrition education, prescriptions for nutrient supplements, screenings for anemia, and dietary assessments. A greater proportion of the women at high risk received the interventions than did women at lower risk. The presence of educational components and assays for anemia were associated with a lower risk of a LBW delivery in the total group and in the high risk groups.

The sensitivity and specificity of a preterm risk score for various patient populations.

Scoring systems to identify women at high risk for delivering low birthweight infants are used to place high-risk women into special prenatal clinics. The March of Dimes Birth Defects Foundation scoring system was evaluated to determine its sensitivity, specificity, and positive predictive value at each cutoff point between 0 and 20 for various patient profiles when conducted before 29 weeks' gestation. In the present study, 9014 singleton births in 1985 and 1986 from nine Florida county health units were reviewed. Scores of 1, 5, 10, and 20 provided a sensitivity of 0.96, 0.66, 0.26, and 0.02, a specificity of 0.05, 0.44, 0.86, and 0.99, and a positive predictive power of 8.7, 10.1, 15.9, and 21.1, respectively. Differences in the sensitivity and specificity of the scores existed among subsets in the study population classified by gravida, age, race, and urban or rural county. Overall, the applicability was restricted, and the positive predictive value appeared best if a cutoff point of 15 was used, which represented the upper 5th percentile of the population. It was concluded that a greater emphasis was needed to designate scores for specific subpopulations and to give more consideration to psychosocial factors associated with having low birthweight infants.

Weekly food servings and participation in social programs among low income families.

Low income families were interviewed to determine factors related to the number of family food servings per week. A multiple regression model indicated that participation in WIC (supplemental food program for women, infants and children), household size, and number of different income sources were associated with more family food servings per week. Number of food servings per week decreased the last week of the month most often in families with younger members.

Nutritional implications of medication use and misuse in elderly.

Factors responsible for an increased risk of drug-nutrient interactions in the elderly are an increased exposure to drug use for chronic health conditions and the greater chance for marginal diets deficient in nutrients. Poor patient compliance and physicians' prescribing patterns further complicate the risk. Several nutrient-drug interactions cause changes in drug efficacy and affect nutritional status. To identify and assess elderly patients at risk, each should be evaluated through socioeconomic, dietary, and clinical parameters. The health-care team must be knowledgeable regarding drug interactions to properly intervene using a multidisciplinary approach. An intervention program could prevent a decline in the elderly's health status, reduce healthcare costs and improve the quality of life.

Within month variability in use of soup kitchens in New York State. p4.

This paper describes the variation in use of soup kitchens throughout the month using data from the New York State Nutritional Surveillance Program. Excluding November, December, and May, when holiday meals created a different pattern of use, number of meals served in soup kitchens generally increased toward the end of the month, averaging 43 per cent higher for Upstate and 14 per cent higher for New York City in the last week as compared to the first week of the month. The overall increase throughout the month and difference in the magnitude of increase between Upstate and New York City corresponds to the timing of income maintenance benefits distribution. Distribution of most public assistance benefits occurs at the beginning of each month in Upstate, whereas it is staggered in New York City throughout the month.

Intestinal helminthiases in relation to the socioeconomic environment of Panamanian children.

A cross-sectional investigation was made into ascariasis and nutritional status in Panamanian preschool children from October 1983 to July 1984. Within this framework, an analysis was undertaken of possible relationships between a range of intestinal helminthiases and the socioeconomic status of the participants. Attention was paid to caregiver's education, parental occupation, family earnings, quality of housing and sanitation in the assessment of socioeconomic status. On this basis, strong associations were established between the socioeconomic status of the children and infection with Ascaris lumbricoides, Trichuris trichiura and hookworm. In general, the prevalence of single and multiple helminth infections was significantly higher in children living in housing made of wood or bamboo than in those living in housing made of concrete blocks. The same pattern applied to levels of sanitation. Ascaris lumbricoides occurred more frequently in children of mothers with the least formal education and in children living in relatively crowded conditions. Evidence was also obtained to indicate that the intensity of the intestinal helminth infections was greater in the children from the poorer environment. Since children from poorer socioeconomic conditions might be more exposed to infective stages than those from a better environment, the possible role of socioeconomic factors in contributing to the predisposition of some individuals to harbour large worm burdens of intestinal helminths was briefly discussed.

Contributions of ascariasis to poor nutritional status in children from Chiriqui Province, Republic of Panama.

Relationships between ascariasis and lactose digestion and between ascariasis and food transit time from mouth to caecum were investigated in young children from Chiriqui Province, Republic of Panama. The breath hydrogen method was used in both studies. Ascaris-infected children showed a significantly poorer degree of lactose digestion following a test oral load than uninfected children. Recovery of the capacity of the children to digest lactose was still not fully complete for at least 3 weeks following anthelmintic treatment. On average, the mouth-to-caecum transit time was similar in infected and uninfected children, but among the Ascaris-infected children the transit time tended to be shorter in relation to the intensity of infection. Evidence from a cross-sectional survey indicated that ascariasis was significantly associated with reduced plasma vitamin A and carotenoid concentrations. This relationship remained after controlling for a range of socio-economic variables. Ascaris-infected children were frequently found to have lower haematocrits and blood haemoglobin concentrations than uninfected children, but these relationships could not be attributed to ascariasis alone.

Ascaris lumbricoides infection in pre-school children from Chiriqui Province, Panama.

An epidemiological survey of intestinal parasitic infections was conducted in a sample of 203 children aged 3-5 years from a semi-urban and a rural community in Chiriqui, Panama, in 1983-4. On the basis of stool examinations, the prevalences of Ascaris lumbricoides, Trichuris trichiura, hookworm, Giardia intestinalis, Entamoeba spp. and Strongyloides stercoralis were found to be 27, 34, 14, 15, 5 and 4% respectively. The results from children from the two communities were compared. Polyparasitism occurred significantly more often in rural than semi-urban children. Following anthelmintic treatment with levamisole, the numbers of A. lumbricoides passed/child were recorded and the frequency distribution of the parasite was observed to be highly aggregated with a variance to mean ratio of 10.2. For A. lumbricoides, relationships between worm burden, worm biomass and egg production were investigated. In the data analysis, an attempt was made to explore the influence of numbers of male worms on egg production. The results are compared with those obtained during other recent studies on the epidemiology of A. lumbricoides infection in other countries.

Increasing the breaking strength of wounds exposed to preoperative irradiation using vitamin E supplementation.

This study investigated if the prophylactic administration of vitamin E, an antioxidant, normalizes the healing of wounds exposed to preoperative ionizing radiation. Vitamin E was given intraperitoneally to three experimental groups of rats every other day at doses of 10, 20 or 40 International Units (IU) until a total dose of 30, 60 or 120 IU respectively was administered. There were three control groups: non-irradiated control, irradiated, non-supplemented control and irradiated, sesame oil-supplemented control. Two days following the last vitamin E or sesame oil injection 600 Rads of local radiation was delivered to the area of wounding. Two hours following the radiation treatment five centimeter long incisions were made in the area of radiation. There was no difference in the growth of the rats. Radiation exposure significantly reduced the breaking strength (g/5 mm wound) of the wounds compared to non-irradiated controls. With increasing levels of vitamin E there was an increase in the breaking strength of wounds (Y = 360.0 + 0.64 X, SE = 0.27, p less than 0.01). This study provides evidence suggesting that vitamin E may help normalize the breaking strength of wounds that receive preoperative irradiation.