School lunch: a comparison of the fat and cholesterol content with dietary guidelines.

OBJECTIVE: To compare the fat and cholesterol content of the foods offered and selected in an elementary school lunch program with current dietary guidelines. DESIGN: For 105 school days we recorded the food items selected by elementary school students in an entire school district (262,851 meals) who were given a choice between two entrees. The nutrient content of foods was assessed with a computerized nutrient data base supplemented by the food manufacturers' data. SETTING: Sixteen elementary schools in the Bellevue (Washington) School District. PARTICIPANTS: The number of students eating school lunch averaged 2500 per day, of whom 25% were from households with incomes less than 185% of poverty. INTERVENTION: None. MAIN OUTCOME MEASURES: We determined the nutritional content of the average meal selected; the proportion of days when one of the two offered entrees met fat and cholesterol guidelines; and the proportion of children selecting the entrees that met the guidelines. RESULTS: The average lunch selected had 35.9% of calories from total fat and 12.6% from saturated fat, exceeding the guidelines of 30% and 10%, respectively. Lunch contained an average of 57 mg cholesterol (106 mg/1000 kcal) and met guidelines. One of the two daily entree choices met guidelines for both total fat and saturated fat on 20% of days, and met both fat and cholesterol guidelines on 14% of days. When available, entrees meeting the fat guidelines were chosen by 37% of students, and entrees meeting both fat and cholesterol guidelines were chosen by 34% of students. CONCLUSIONS: In this school district the average lunch selected did not meet the current guidelines for dietary fat; when given the choice, more than one third of students selected the entrees that met these guidelines.

Low risk of vertebral fracture in Mexican American women.

Ethnicity is important in assessing risk for osteoporotic fractures, and should be considered in decision-making about the use of prophylactic treatments. Few data are available, however, on fracture risks among Hispanic patients. To assess the risk of vertebral fracture in Mexican Americans, we determined the prevalence of vertebral fracture among 822 patients, aged 15 to 86 years, who underwent spinal roentgenography in a study of low-back pain. After adjusting for age, use of steroids, drug or alcohol abuse, and recent trauma, the odds ratio for Mexican American women compared with non-Hispanic whites was 0.55 (95% confidence interval, 0.32 to 0.95), indicating a substantially lower risk. These results are concordant with earlier data documenting a reduced risk of hip fracture among Mexican American women. Thus, recommendations for prophylactic treatments for osteoporosis may be different for Mexican Americans than for non-Hispanic whites.

Risk of postmenopausal hip fracture in Mexican American women.

To assess the risk of hip fracture in Mexican Americans, the ethnicity of 80 women aged 50 years and over admitted with hip fractures to a Texas hospital was compared with that of age-matched women hospitalized for other reasons. The risk of fracture for Mexican Americans was only 35 per cent that of Whites (95% CI = 19 per cent, 65 per cent). This finding was confirmed in a chart survey performed in a second hospital population. These results suggest that Mexican American women may receive less potential benefit from preventive measures for hip fracture than Whites.

A simple language-based acculturation scale for Mexican Americans: validation and application to health care research.

A simple scale for quantifying English use among Mexican Americans was constructed from four brief questions which proved to have excellent scaling characteristics by Guttman Scalogram Analysis in two independent data sets. Construct validity was established by significant associations of the scale with ethnicity, place of birth, generation within the United States, and type of neighborhood. Highly significant associations were found between scale scores and use of oral contraceptives, parity, "fatalism" regarding health, and attitudes toward folk healers. These associations remained significant (though weak) after controlling for education and family income. The language scale thus appears to be reliable and valid, to be capable of distinguishing meaningful subsets among the Mexican American population, and to be applicable to health care investigation.

Pitfalls in measuring the health status of Mexican Americans: comparative validity of the English and Spanish Sickness Impact Profile.

We tested a Spanish translation of the Sickness Impact Profile (SIP) in a clinical study of low back pain, which included non-Hispanic patients (Group I), Mexican Americans who used the English SIP (Group II), and Mexican Americans who used the Spanish SIP (Group III). The reliability and clinical validity of responses by these three groups were compared. Internal consistency of responses by all three groups was excellent ( Cronbach 's alpha for the overall SIP = .93 - .95). When construct validity was tested by correlating SIP scores with several clinical measures of disease severity, however, important differences emerged. Group I responses appeared to be highly valid, while group III responses did not; Group II responses appeared reasonably valid, but intermediate between the other groups. These differences appear unlikely to be due to clinical differences, interviewing, or translational problems and seem to parallel the groups' levels of "acculturation." It may be that certain aspects of acculturation, including familiarity with questionnaire research, critically affect the validity of responses to this questionnaire.