Background It is known that obesity, sodium intake, and alcohol consumption influence blood pressure. In this clinical trial, Dietary Approaches to Stop Hypertension, we assessed the effects of dietary patterns on blood pressure. Methods We enrolled 459 adults with systolic blood pressures of less than 160 mm Hg and diastolic blood pressures of 80 to 95 mm Hg. For three weeks, the subjects were fed a control diet that was low in fruits, vegetables, and dairy products, with a fat content typical of the average diet in the United States. They were then randomly assigned to receive for eight weeks the control diet, a diet rich in fruits and vegetables, or a “combination” diet rich in fruits, vegetables, and low-fat dairy products and with reduced saturated and total fat. Sodium intake and body weight were maintained at constant levels. Results At base line, the mean (±SD) systolic and diastolic blood pressures were 131.3±10.8 mm Hg and 84.7±4.7 mm Hg, respectively. The combination diet reduced systolic and d...

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A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure

Assessment of fracture risk and its application to screening for postmenopausal osteoporos

Obesity now affects one in five children in the United States. Discrimination against overweight children begins early in childhood and becomes progressively institutionalized. Because obese children tend to be taller than their nonoverweight peers, they are apt to be viewed as more mature. The inappropriate expectations that result may have an adverse effect on their socialization. Many of the cardiovascular consequences that characterize adult-onset obesity are preceded by abnormalities that begin in childhood. Hyperlipidemia, hypertension, and abnormal glucose tolerance occur with increased frequency in obese children and adolescents. The relationship of cardiovascular risk factors to visceral fat independent of total body fat remains unclear. Sleep apnea, pseudotumor cerebri, and Blount's disease represent major sources of morbidity for which rapid and sustained weight reduction is essential. Although several periods of increased risk appear in childhood, it is not clear whether obesity with onset early in childhood carries a greater risk of adult morbidity and mortality. Obesity is now the most prevalent nutritional disease of children and adolescents in the United States. Although obesity-associated morbidities occur more frequently in adults, significant consequences of obesity as well as the antecedents of adult disease occur in obese children and adolescents. In this review, I consider the adverse effects of obesity in children and adolescents and attempt to outline areas for future research. I refer to obesity as a body mass index greater than the 95th percentile for children of the same age and gender.

Health Consequences of Obesity in Youth: Childhood Predictors of Adult Disease

• This report of an expert panel of the National Cholesterol Education Program provides new guidelines for the treatment of high blood cholesterol in adults 20 years of age and over. Total cholesterol levels are classified as follows: ( Arch Intern Med 1988;148:36-69)

Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults

The authors assessed the reproducibility and validity of an expanded 131-item semiquantitative food frequency questionnaire used in a prospective study among 51,529 men. The form was administered by mail twice to a sample of 127 participants at a one-year interval. During this interval, men completed two one-week diet records spaced approximately 6 months apart. Mean values for intake of most nutrients assessed by the two methods were similar. Intraclass correlation coefficients for nutrient intakes assessed by questionnaires one year apart ranged from 0.47 for vitamin E without supplements to 0.80 for vitamin C with supplements. Correlation coefficients between the energy-adjusted nutrient intakes measured by diet records and the second questionnaire (which asked about diet during the year encompassing the diet records) ranged from 0.28 for iron without supplements to 0.86 for vitamin C with supplements (mean r = 0.59). These correlations were higher after adjusting for week-to-week variation in diet record intakes (mean r = 0.65). These data indicate that the expanded semiquantitative food frequency questionnaire is reproducible and provides a useful measure of intake for many nutrients over a one-year period.

Reproducibility and Validity of an Expanded Self-Administered Semiquantitative Food Frequency Questionnaire among Male Health Professionals

To provide a contemporary profile of blood pressure and nutritional and sociodemographic relationships in the adult US population, data from the first National Health and Nutrition Examination Survey ( NHANES -I), 1971-1975, were analyzed. Systolic and diastolic blood pressures increased with increasing age, but trends were different by sex and race groups. Body mass index (weight/ height2 ) was the nutritional factor most strongly and consistently related to blood pressure. Among dietary constituents, alcohol consumption and calcium and phosphorus intake were the only variables having consistent and independent relationships to blood pressure. Sodium content of food and salt use had no relationship, and sodium/potassium food content had only an inconsistent association. Regarding serum nutritional measures, serum calcium was directly related and serum phosphorus was inversely related to blood pressure. Serum urate, serum aspartate aminotransferase, and hemoglobin were also independently related to systolic and diastolic blood pressures. There were few important differences by race or sex in these correlates. These observations from a representative sample of the US population have useful implications for prevention and treatment of high blood pressure.

Blood pressure and nutrition in adults the national health and nutrition examination survey

The 1-day food intakes of 1,338 women, aged 19 to 50, who were respondents in the 1985 Continuing Survey of Food Intake by Individuals, were studied. The energy, nutrient, and food intake patterns of smokers, those who had quit smoking, and those who had never smoked cigarettes were compared. Mean energy intakes of smokers (1,627 kcal), those who had never smoked (1,620 kcal), and those who had quit at least 1 year before the interview (1,719 kcal) were not significantly different. Self-reported body weight was significantly different between never-smokers and smokers (p

Dietary patterns of women smokers and non-smokers.

Sixteen days of dietary recall and records collected over 1 year for 228 respondents were compared with an estimate of "usual" diet based on a 116-item food frequency questionnaire (FFQ) for the study year. Respondents were white and black men and women aged 24 to 51. Mean energy values for the total group were 2,111 kcal for the recall/records and 2,766 kcal for the FFQ, a 31% difference. The mean food energy and nutrient values obtained by the FFQ were consistently and significantly higher than the mean recall/record values for all four race-sex groups, although the degree of difference varied by nutrient, food group, and demographic characteristics of the respondents. For the nutrients compared, the smallest difference between methods was for protein--27% for the total group. The greatest difference was for vitamin A--123% for the total sample. Sex-race specific correlation coefficients between methods were relatively high for calcium, vitamin C, and iron.

Comparison of estimated nutrient intakes by food frequency and dietary records in adults.

Data from a representative sample of the U.S. adult population obtained during 1971-1975 were analyzed to provide a profile of blood pressure (BP) levels and related nutritional and sociodemographic factors. Older adults (aged 55-74 years) had a twofold greater prevalence of high BP than younger adults (25-54 years), and older black persons had the highest rates. Isolated systolic elevation was uncommon under 54 years of age, but occurred in 5% to 10% of adults over 55 years and was less common than systolic-diastolic elevation. In older adults, body mass (weight/height2) had the strongest relationship to BP of all the nutritional variables. Alcohol consumption and dietary calcium and phosphorus were associated with high BP, but dietary sodium and salt use were not. The serum calcium/phosphorus ratio and serum urate were significantly higher in older adults with high BP. In general, the variables associated with elevated BP in older adults were similar to those in younger adults, although the strengths of the associations differed. Associations of factors useful for nonpharmacologic prevention and management of high BP in older persons were suggested from this survey.

High blood pressure in older Americans. The First National Health and Nutrition Examination Survey.

As shown in 744 adult men and women aged 30-49 at entry and followed for 21.4 ± 0.9 years there is continuing subperiosteal expansion in both sexes as well as continuing and increasing endosteal surface resorption. In this longitudinal study, bone loss (as shown by medullary cavity expansion) begins by the 5th decade and increases thereafter. The smaller gains at the outer bone surface are essentially independent of the larger losses at the inner (endosteal) surface and neither functionally nor causally related. Though bone loss and net bone loss is nearly as great in men as in women, absolutely speaking, two-decade bone loss constitutes a larger percentage of the initially smaller bone mass in the female. In both sexes subperiosteal apposition (delta TA) and endosteal resorption (delta MA) are bone-size dependent though in diametrically opposite directions. These trends in two-decade bone change are not affected by smoking behavior, alcoholic beverage usage, antihypertensive usage, or early menopausal age. Similarly, the long-term bone changes prove to be independent of energy and mineral intakes and to long-term changes in calcium, phosphorus, magnesium, and vitamin D intake. Though dietary intakes do not predict long-term bone changes, the amount of tissue bone present at entry is highly correlated (> 0.93) with tissue bone 21.4 years later in men and women alike. Accordingly, only a small amount of intraindividual cortical variance in the later years still remains to be explained by life-style, dietary, medication, and error variables.

Frances A. Larkin

Papers

Blood pressure and nutrition in adults the national health and nutrition examination survey

Dietary patterns of women smokers and non-smokers.

Comparison of estimated nutrient intakes by food frequency and dietary records in adults.

High blood pressure in older Americans. The First National Health and Nutrition Examination Survey.

Continuing bone expansion and increasing bone loss over a two-decade period in men and women from a total community sample