Showing papers in "Journal of The American Dietetic Association in 1993"

Reproducibility and validity of food intake measurements from a semiquantitative food frequency questionnaire

Abstract: Few food frequency questionnaires have been evaluated for their ability to assess intakes of individual foods that may be related to disease independently of their nutrient content. The reproducibility and validity of food intake measurements by a 131-item semiquantitative food frequency questionnaire were evaluated in a sample of 127 men from the Health Professionals Follow-up Study, a large longitudinal study of diet and disease. Each subject completed two questionnaires 1 year apart and two 1-week diet records 6 months apart during the intervening year. Pearson correlations assessing reproducibility between food intakes from the two questionnaires ranged from .31 for pie to .92 for coffee (mean = .59). Validity was measured by comparing food intakes from the second questionnaire with those from the diet records. Pearson correlations corrected for within-person weekly variation in diet record data ranged from .17 for other nuts to .95 for bananas (mean = .63). Large within-person variation precluded the calculation of accurate validity correlations for 29 foods. As we previously observed in women, the foods most often overreported were fruits and vegetables, and meats and dairy products were most often underreported. With few exceptions, reasonable levels of reproducibility and validity were observed for intake of individual foods in this extensive food frequency questionnaire.

Carotenoid content of fruits and vegetables: An evaluation of analytic data

Abstract: The test of the association between dietary intake of specific carotenoids and disease incidence requires the availability of accurate and current food composition data for individual carotenoids. To generate a carotenoid database, an artificial intelligence system was developed to evaluate data for carotenoid content of food in five general categories, namely, number of samples, analytic method, sample handling, sampling plan, and analytic quality control. Within these categories, criteria have been created to rate analytic data for β-carotene, α-carotene, lutein, lycopene, and β-cryptoxanthin in fruits and vegetables. These carotenoids are also found in human blood. Following the evaluation of data, acceptable values for each carotenoid in the foods were combined to generate a database of 120 foods. The database includes the food description; median, minimum, and maximum values for the specific carotenoids in each food; the number of acceptable values and their references; and a confidence code, which is an indicator of the reliability of a specific carotenoid value for a food. The carotenoid database can be used to estimate the intake of specific carotenoids in order to examine the association between dietary carotenoids and disease incidence.

Measurements of total energy expenditure provide insights into the validity of dietary measurements of energy intake

Abstract: The quantification of errors inherent in methods of measuring dietary intake has been handicapped by the absence of independent markers for testing their validity. The doubly labeled water technique permits a precise measure of energy expenditure in free-living persons. Because energy expenditure must equal energy intake in populations in energy balance, this technique may be used to validate the assessment of energy intake. A series of studies demonstrated good agreement between mean energy intake and mean energy expenditure when food intake was recorded by observers or when it was self-reported by normal-weight, self-selected, highly motivated volunteer subjects using weighed records. However, in randomly recruited men and women, energy intake by weighed records was 82% and 81%, of energy expenditure, respectively, indicating underestimation of habitual intake. Men and women in the lowest third of reported intake recorded energy expenditure of only 69% and 61%, respectively. Reported intake of obese and previously obese women was only 73% and 64% of expenditure, whether measured by weighed record or by diet history, confirming suspicions that these subjects misrepresented their intake. Acceptable weighed records were obtained from 7- and 9-year-olds whereas 15- and 18-year-olds underestimated intake. Diet histories taken from the same children tended to overestimate intake. These studies suggest that, ideally, all dietary studies should include independent measures of validity.

Weight-related attitudes and behaviors of black women

Abstract: Weight-related attitudes and practices of women who attended health department clinics or who worked for a health and human services agency were assessed by means of an anonymous, self-administered questionnaire. Black women who were 25 to 64 years old and were not pregnant or had not given birth within the past year were included in this analysis (n = 500). The overweight women perceived themselves as being overweight. They were less likely to be satisfied with their weight and more likely to have dieted and to be currently dieting than nonoverweight women. Awareness of obesity-related health risks was high, but the perceived psychosocial consequences of being overweight were somewhat limited. Approximately 40% of moderately and severely overweight women considered their figures to be attractive or very attractive, which indicates a relatively positive body image. The overweight women were less likely to exercise, less likely to skip meals, and more likely to eat between meals than the nonoverweight women. Among the subset who had ever attempted to lose weight (n = 368), the overweight women were significantly more likely to have regained all or more of the weight lost during their most recent attempt. The findings of this exploratory survey suggest that although overweight black women are weight conscious, the absence of strong negative social pressure combined with a relatively positive body image may limit the extent to which weight loss efforts are sustained. Findings about eating and exercise patterns suggest some specific factors that may interfere with the effectiveness of weight control among black women.

Validation of 24-hour recalls assisted by food records in third-grade children

Abstract: Objective The objective of the study was to validate the use of 24-hour recalls assisted by food records as a dietary assessment tool for use with third-grade children. Design Trained staff observed children during mealtime at school, and parents observed and recorded what children ate in their presence. The following day children participated in a 24-hour recall interview. Children's ability to recall what they consumed during a 24-hour period was compared with observational data collected during the same period. Setting All data were collected in elementary school settings at four sites involved in the Child and Adolescent Trial for Cardiovascular Health. Subjects The sample of 49 children was self-selected, based on parents' willingness to observe and record their child's food intake. Main outcome measures Recalled and observed data for energy and nutrient levels were compared using mean energy and nutrient analysis and quartile classification. In addition, recalled and observed foods were compared by meal type and estimation of portion size. Statistical analysis performed Paired t tests, Pearson and Spearman correlations, and classification analysis were used to compare recalled and observed data. Results Comparison of observed and recalled food intakes showed no significant differences in percentage of energy from total fat, saturated fat, monounsaturated fat, and polyunsaturated fat or in the amount of sodium consumed, although there were differences in energy intakes. Spearman rank order correlations between recalled and observed nutrients ranged from .45 to .79. A 77.9% agreement was found across all meals in the food items children recalled having consumed compared with those adults actually observed them consuming. Conclusions We conclude that the 24-hour recall assisted by food records is a valid method for assessing the dietary intake of children as young as 8 years old for the purpose of group comparison.

The development and application of a carotenoid database for fruits, vegetables, and selected multicomponent foods

Abstract: A carotenoid database for individual and multicomponent foods has been compiled that contains values for the five most common carotenoids (alpha-carotene, beta-carotene, beta-cryptoxanthin, lycopene, lutein) in 2,458 fruits, vegetables, and multicomponent foods containing fruits and vegetables. The database was used to estimate intakes of specific carotenoids for 19- to 50-year-old women (n = 1,102), using food consumption data obtained from dietary recalls in the US Department of Agriculture Continuing Survey of Food Intake by Individuals, 1986. The major contributors of alpha-carotene were carrots consumed as a single food or as an ingredient in multicomponent foods. Carrots, cantaloupe, and broccoli were the main sources of beta-carotene. Orange juices and blends, oranges, and tangerines were important contributors of beta-cryptoxanthin. Tomatoes and tomato products consumed as single foods or as ingredients in multicomponent foods provided most of the dietary lycopene. Contributors of lutein + zeaxanthin included collard, mustard, or turnip greens; spinach; and broccoli. The per capita consumption of total carotenoids (the sum of the five specific carotenoids) among these women was approximately 6 mg/day.

Breakfast consumption affects adequacy of total daily intake in children

Abstract: Breakfast consumption patterns were assessed for 467 10-year-old children (59% white, 50% girls), who were interviewed in 1984–1985 or in 1987–1988. Consumption patterns were then related to mean daily nutrient intake patterns. More whites (56%) and more girls (46%) ate breakfast at home, whereas more blacks (58%) and more boys (49%) ate breakfast at school. Results indicated that 16% of all children skipped breakfast; the highest percentage was in black girls (24%). Breakfast consumption made a significant contribution to the child's mean daily nutrient intake. The average total energy intake was significantly lower for children who did not consume breakfast (mean = 1,821 kcal) and for children who consumed breakfast at home (mean = 2,098 kcal) compared with children who consumed breakfast at school (mean = 2,326 kcal). A similar pattern was noted for macronutrient contribution. Percentage of total energy from fat was lower in children who did not eat breakfast (34%) compared with those who did (37% to 39%), yet percentage of energy from carbohydrate was higher (53%) in children who did not eat breakfast. Children who skipped breakfast did not make up the differences in dietary intakes at other meals. A higher percentage of children who did not consume breakfast compared with those who ate breakfast did not meet two thirds of the Recommended Dietary Allowance for vitamins and minerals. These data confirm the importance of breakfast to overall dietary quality and adequacy in school-age children.

Effect of dietary oxalate and calcium on urinary oxalate and risk of formation of calcium oxalate kidney stones

Abstract: Dietary restriction of oxalate intake has been used as therapy to reduce the risk of recurrence of calcium oxalate kidney stones. Although urinary oxalate is derived predominantly from endogenous synthesis, it may also be affected by dietary intake of oxalate and calcium. The risk of increasing urinary oxalate excretion by excessive consumption of dietary oxalate is greatest in individuals with a high rate of oxalate absorption, both with and without overt intestinal disease. Although oxalate-rich foods enhanced excretion of urinary oxalate in normal volunteers, the increase was not proportional to the oxalate content of the food. Only eight foods—spinach, rhubarb, beets, nuts, chocolate, tea, wheat bran, and strawberries—caused a significant increase in urinary oxalate excretion. Restriction of dietary calcium enhances oxalate absorption and excretion, whereas an increase in calcium intake may reduce urinary oxalate excretion by binding more oxalate in the gut. This review of the literature indicates that initial dietary therapy for stone-forming individuals can be limited to the restriction of foods definitely shown to increase urinary oxalate. The effects of oxalate-restricted diets on urinary oxalate should be evaluated by means of laboratory analyses of urine composition. Subsequent long-term therapy can be recommended if beneficial results are obtained from oxalate restriction at an appropriate calcium intake.

Hospital-associated malnutrition: a reevaluation 12 years later

Abstract: A prospective evaluation of general medical patients at the University of Alabama at Birmingham was performed in 1976 and repeated in 1988 to determine change in malnutrition prevalence. Plasma folate, plasma ascorbate, weight for height, triceps skinfold, arm muscle circumference, lymphocyte count, albumin, and hematocrit measurements were combined to form a likelihood of malnutrition (LOM) score. The nutritional status of 228 consecutive patients was assessed by the LOM score at admission and at the 14th day of hospitalization and compared with 1976 findings. The same testing methods were used and the same patient diagnoses and demographic characteristics were found in 1988 and 1976. Of the patients staying more than 14 days, the length of stay was the same in 1988 and 1976 (30 days and 31 days, respectively). However, a smaller percentage of patients stayed 2 weeks or longer in 1988 (21% vs 33% in 1976). In 1988, high LOM scores at admission predicted longer lengths of stay and showed a trend toward increased mortality. The 1976 findings also showed that high LOM scores were associated with longer lengths of stay and increased mortality. LOM scores paired from admission to follow-up improved with stay in 1988 and worsened in 1976. The number of patients with high LOM scores at follow-up was lower in 1988 than in 1976 (46% and 62%, respectively). These findings indicate that identification of malnutrition indicators has improved since 1976. However, dietitians should continue to improve the nutrition assessment and intervention process.

Nutrition interventions for intensive therapy in the diabetes control and complications trial

Abstract: As part of an intensive treatment regimen that had as its goal achieving and maintaining blood glucose levels in the normal range in individuals with insulin-dependent diabetes mellitus, dietitians in the Diabetes Control and Complications Trial implemented varying nutrition intervention strategies to counsel patients to attain normoglycemia. Dietary management encompassed recommendations on altering insulin dosages for varying food intake. Nutrition intervention was tailored to best meet a participant's life-style, motivation, ability to grasp information, diet history, and specific intensive insulin therapy. Dietitians were integral participants in the team management of individuals in the intensive treatment group. Selected nutrition interventions—Healthy Food Choices, exchange systems, carbohydrate counting, and total available glucose—and behavior management approaches were coupled with intensive insulin therapy. Case presentations illustrate each nutrition intervention in the attainment of normoglycemia.

Are n-3 fatty acids essential nutrients for fetal and infant development?

Abstract: Recent research indicates that n-3 fatty acids (FAs) are essential nutrients in early human development. In human infants, nonhuman primates, and animal models, the n-3 FA, docosahexaenoic acid (DHA, 22:6n-3) is highly concentrated in brain and retinal tissues and accumulates during late fetal and early neonatal life. Diets deficient in n-3 FAs are associated with reduced levels of DHA in erythrocytes and brain and retinal tissues and with abnormalities in retinal function that may be irreversible. The precursor of DHA, α-linolenic acid (LNA, 18:3n-3), may be an inadequate substitute for DHA because LNA may not be converted to DHA in sufficient amounts to meet an infant's needs. Premature infants lose DHA from their tissues unless they are fed human milk or formula supplemented with DHA. fish and shellfish are the main food sources of DHA. Women who consume fish have more DHA in their breast milk than do those who do not eat seafood. Infant formulas contain only LNA as a source of n-3 FAs. Pregnant and nursing women should be encouraged to consume seafood on a regular basis during pregnancy and lactation to furnish DHA for their infants.

Significance of obesity on nutritional, immunologic, hormonal, and clinical outcome parameters in burns

Abstract: Objective The potential additive effect of obesity on selected nutritional, immunologic, hormonal, and clinical outcome parameters was evaluated. Design Fifteen obese patients were randomly matched for age, percentage of burn, percentage of third-degree burn, and inhalation injury to 15 nonobese patients. Setting Subjects were admitted to Shriners Burns Institute or University Hospital in Cincinnati, Ohio. Results The results of this study established a significant relationship between obesity and morbidity. Incidence of infection was greatest in the obese group ( P P P P P P Applications/conclusions The data demonstrate the many metabolic and biochemical aberrations associated with obesity, distinct from the burn injury itself, and suggest that the overweight burn patient is at increased risk of morbidity. Given the prevalence of obesity in the United States, greater attention clearly needs to be given to its prevention and management.

The Dietary Intervention Study in Children (DISC): Dietary assessment methods for 8- to 10-year-olds

Abstract: Objectives The dietary assessment methods used in the Dietary Intervention Study in Children (DISC) are described and the rationale, validity, and/or general usefulness of each are discussed. Design DISC is the first multicenter, randomized, clinical trial to study the feasibility and long-term efficacy, safety, and acceptability of a fat-modified diet in 8- to 10-year-old prepubescent children with moderately elevated plasma low-density lipoprotein cholesterol (LDL-C) levels. Final data collection for the original study (DISC I) occurred December 1, 1993; continued intervention and follow-up (DISC II) will extend beyond 1997. Setting Six clinical centers across the country participate in DISC. Subjects Preadolescent boys and girls with fasting LDL-C levels between the 80th and 98th age-specific and sex-specific percentiles established by the Lipid Research Clinics were eligible for the study. The feasibility phase included 140 children who were then enveloped into the full-scale trial. Baseline dietary data for 652 randomized children in the full-scale trial and 6-month results for the feasibility cohort are reported. Interventions Dietary assessment involved several elements: (a) determining eligibility based on consumption of more than 30% of energy from total fat, (b) monitoring adherence to and adequacy of the intervention diet, (c) evaluating acceptability of the diet in the intervention group, and (d) determining appropriate foods for the intervention diet. Methods are described for each purpose. Main outcome measures LDL-C differences between the two groups and differences in total and saturated fat intakes as calculated from three 24-hour recalls were the primary outcome measures. Six-month dietary differences in the feasibility group are reported. Statistical methods Baseline group means and 6-month differences in dietary intake are reported for the full-scale trial and feasibility study, respectively. Results Baseline mean intake from three dietary recalls for the intervention (n = 328) and control (n = 324) groups, respectively, were as follows: energy=1,759 kcal and 1,728 kcal; total energy from fat=33.3% and 34.0%; total energy from saturated fat=12.5% and 12.7%; and total dietary cholesterol=209 mg and 195 mg. After 6 months of intervention, percentage of energy from total fat and saturated fat was reduced by 5.1% ( P = .004) and 2.9% ( P Applications/conclusions Results illustrate the feasibility of implementing a variety of dietary assessment methods among preadolescent children without relying primarily on parental reports.

Thiamin Status, Diuretic Medications, and the Management of Congestive Heart Failure

Abstract: Objective To assess the prevalence of thiamin deficiency in patients with congestive heart failure who are treated with diuretics that inhibit sodium and chloride reabsorption in the thick ascending limb of the loop of Henle (loop diuretic therapy). Design A cross-sectional investigation of thiamin status of consecutive patients with congestive heart failure being treated with loop diuretic therapy. Setting Cardiology clinic of a midwestern tertiary-care medical center. Subjects Thirty-eight patients were recruited (mean age±standard deviation=55±14 years). Validation of methodology was conducted with nine age-matched control subjects. Main outcome measures Thiamin status was assessed biochemically by in vitro erythrocyte transketolase activity assay. Assessment of dietary intake of thiamin was accomplished with a semiquantitative food frequency questionnaire. Statistical analyses performed Fisher's exact test and logistic regression were used to evaluate relationships between thiamin status and variables of interest. Results Biochemical evidence of thiamin deficiency was found in 8 of 38 (21%) patients. Evidence of risk for dietary thiamin inadequacy was found in 10 of 38 patients (25%). Seven of the 8 patients with biochemical evidence of thiamin deficiency met study criteria for dietary adequacy, although quantified data suggested that only 4 of the patients achieved two thirds of the Recommended Dietary Allowance. Biochemical evidence of thiamin deficiency tended to be more common among patients with poor left ventricular ejection fractions ( P =.07). Conclusions Thiamin deficiency may occur in a substantial proportion of patients with congestive heart failure, and dietary inadequacy may contribute to increased risk. J Am DietAssoc. 1995; 95:541-544.

Food pattern, diet quality, and related characteristics of schoolchildren in New York State

Abstract: Objectives To examine the food patterns and diet quality of elementary schoolchildren in New York State (outside of New York City) and to determine sociodemographic characteristics correlated with diet quality. Design A nonquantitative 24-hour recall administered to students and a brief questionnaire completed by parents. Sample 1,797 second and fifth graders (51% of those asked) in 51 randomly selected schools (46% of those asked) in New York State outside of New York City. Statistical analyses Multiple regression analyses, η 2 , and t tests. Results On the day they were surveyed, 40% of students did not eat vegetables, except for potatoes or tomato sauce; 20% did not eat fruit; 36% ate at least four different types of snack foods, and 16% of fifth graders did not eat breakfast. Children who ate a school lunch ate significantly more dairy foods and fruits and vegetables, and fewer snack-foods than those who brought lunch from home. Fifth graders ate significantly more snack foods and were more likely to skip breakfast than second graders; boys had lower food-group pattern scores than girls; children of lower socioeconomic status had less diverse diets but ate less snack foods than children of higher socioeconomic status; children with single parents were more likely to skip breakfast and to eat fewer vegetables than those with two parents; and children with mothers employed outside the home had less diverse diets than those with mothers at home. Applications/conclusions The findings indicate that nutrition interventions are clearly needed for this age group and that targeted messages should be based on sociodemographic characteristics.

Height, weight, and body mass index of American Indian schoolchildren, 1990–1991

Abstract: Objective To describe the current height and weight status of American Indian children who live on or near Indian reservations nationwide. Subjects 9,464 American Indian schoolchildren aged 5 through 18 years. Statistical analyses performed Data for height, weight, and body mass index of the schoolchildren were compared with two national reference data sets, the second National Health and Nutrition Examination Survey (NHANES II) and the Mexican-American population of the Hispanic Health and Nutrition Examination Survey (HHANES-MA). Results The three populations were similar in height, but the American Indian children weighed more, although not at a statistically significant level, and had a statistically significant higher body mass index than the NHANES II reference population for nearly every age and sex group. The overall prevalence of overweight in the American Indian children (exceeding the 85th percentile of the reference population) was 39.3% compared with the NHANES II population and 28.6% compared with the HHANES-MA population. The overall prevalence of underweight in the American Indian sample was substantially less than the expected 15% compared with either the NHANES II or HHANES-MA population. Applications/conclusions Overweight is much more prevalent in American Indian children than among other children in the United States at all ages and in both sexes. This may have important implications for chronic disease risk and emphasizes the need for targeting obesity prevention efforts to American Indian children.

Expanded role of the dietitian in the diabetes control and complications trial: Implications for clinical practice

Abstract: Initially, the dietitians' role in the Diabetes Control and Complications Trial (DCCT) was specifically defined to include evaluation of potential study volunteers, collection of dietary histories, provision of nutrition education, and participation in team management meetings. As the study progressed, recognition of the importance of adherence to diet in achieving hemoglobin A1c goals and the occurrence of undesirable weight gain in patients assigned randomly to intensive therapy provided an opportunity for dietitians to use their skills intensively and broadly. The need for dietary adherence made DCCT teams aware that dietitians needed to become more active in recruiting and selecting study volunteers and in implementing and evaluating all aspects of intensive diabetes treatment. Increased involvement in these activities allowed dietitians to develop relationships with research patients that were necessary to negotiate treatment goals and improve insights into dietary issues affecting care. Recognition of the importance of dietitians to the DCCT and the empowering nature of the annual meeting of DCCT dietitians fostered continued expansion of the dietitians' role in the clinical centers and in studywide activities such as promotion of dietary adherence, ancillary studies, and publications. Dietitians participating in clinical trials are encouraged to develop their communication and counseling skills, seek out alliances with other team members, and explore opportunities for ancillary research. Such efforts will help to perpetuate this expanded model of the dietitians' role in clinical trials.

Prenatal WIC participation can reduce low birth weight and newborn medical costs: A cost-benefit analysis of WIC participation in North Carolina

Abstract: A number of previous studies have found that prenatal participation in the Special Supplemental Food Program for Women, Infants, and Children (WIC) improves birth outcomes, but only a few studies have provided cost-benefit analyses. The present study linked Medicaid and WIC data files to birth certificates for live births in North Carolina in 1988. Women who received Medicaid benefits and prenatal WIC services had substantially lower rates of low and very low birth weight than did women who received Medicaid but not prenatal WIC. Among white women, the rate of low birth weight was 22% lower for WIC participants and the rate of very low birth weight was 44% lower; among black women, these rates were 31% and 57% lower, respectively, for the WIC participants. Multivariate logistic regression analysis confirmed that prenatal participation in a WIC program reduced the rate of low birth weight. It was estimated that for each $1.00 spent on WIC services, Medicaid savings in costs for newborn medical care were $2.91. A higher level of WIC participation was associated with better birth outcomes and lower costs. These results indicate that prenatal WIC participation can effectively reduce low birth weight and newborn medical care costs among infants born to women in poverty.

Changes in the carbohydrate composition of legumes after soaking and cooking

Abstract: Using a high-performance liquid chromatography (HPLC) method, researchers analyzed the sugar composition of chick-peas, kidney beans, and lentils at various points in the preparation and cooking process: after soaking, after "normal" cooking (ie, boiling), after pressure-cooking, and after cooked legumes had been held at 35°C for 5 hours There was a considerable decrease in the amount of monosaccharides, disaccharides, and raffinose oligosaccharides in chick-peas and kidney beans after soaking and cooking This change in carbohydrate composition was less pronounced when the cooking water was not drained before analysis, which was the method used when analyzing the lentils Method of cooking (either boiling or pressure-cooking) did not have different effects on the sugar composition of chick-peas and lentils, but loss of oligosaccharides was slightly higher when kidney beans were boiled than when they were pressure-cooked Loss of α-galactosides occurred in chick-peas and kidney beans that had been boiled and then held at 35°C for 5 hours The HPLC analysis showed that manninotriose was not one of the oligosaccharides present in these legumes

Changes in resting energy expenditure and body composition in anorexia nervosa patients during refeeding

Abstract: Accurate prediction of the energy level necessary to promote weight restoration in patients with anorexia nervosa would be clinically useful. Resting energy expenditure (REE), respiratory quotient, and body composition were measured in 10 nonmedicated women with anorexia nervosa during a vigorous refeeding protocol. REE was measured three times per week by open-circuit indirect calorimetry after an overnight fast. Subjects ranged in age from 19 to 38 years and weighed 39.9 +/- 4.3 kg (mean +/- standard deviation) at admission. The refeeding protocol was as follows: phase 1, 1,200 kcal/day for 1 week (baseline); phase 2, an increase of 300 kcal/day for 1 week; phase 3, 3,600 kcal/day until target weight was reached; phase 4, 1,800 to 2,800 kcal/day (stabilization). REE was 30.0 +/- 6.4, 33.5 +/- 6.7, 37.3 +/- 6.6 and 34.5 +/- 4.4 kcal/kg body weight during phases 1, 2, 3, and 4, respectively. The Harris-Benedict equation overestimated phase 1 24-hour REE by a mean of 14% and underestimated REE in phases 2, 3, and 4 by a mean of 8%, 24%, and 23%, respectively. Skinfold measurements revealed percent body fat to be 12 +/- 4% at admission and 19 +/- 5% at discharge, with a mean of 48% of the weight gained during refeeding attributable to increased body fat. These findings indicate that refeeding in anorexia nervosa is associated with increased REE, which cannot be explained by increased body mass, and that caloric requirements for weight restoration in patients with anorexia nervosa are best determined by monitoring individual response.

Breast-feeding reduces maternal lower-body fat

Abstract: The effect of breast-feeding on maternal anthropometric measures during the first 6 postpartum months was studied in 24 women. Mothers, who were seen in the hospital shortly after delivery and at monthly intervals thereafter, kept a record of their infant-feeding practices and provided three 24-hour dietary recalls per month. The women were placed in one of three groups according to their infant-feeding practices: breast-feeding exclusively, combination of breast- and formula-feeding, and formula-feeding only. Changes in anthropometric variables at 6 months postpartum were similar in the three groups, but mothers who breast-fed exclusively or partially had significantly larger reductions in hip circumference measurements (3.6% and 3.1%, respectively) and were less above their prepregnancy weights at 1 month postpartum (7.8% and 8.5% above prepregnancy weight, respectively) than mothers who fed formula exclusively (0.68% reduction in hip circumference and 13.7% above prepregnancy weight). Our findings indicate that a woman's choice of infant-feeding practice influences postpartum anthropometric changes, but these effects may be temporary.

Impact of intensified dietary therapy on energy and nutrient intakes and fatty acid composition of serum lipids in patients with recently diagnosed non-insulin-dependent diabetes mellitus

Abstract: Compliance with dietary recommendations and the effect of intensified dietary therapy on energy and nutrient intakes and fatty acid composition of serum lipids were studied in 86 obese subjects (aged 40 to 64 years) with recently diagnosed non-insulin-dependent diabetes mellitus (NIDDM). After three months of basic education, the subjects were randomly separated into an intervention group (n = 40) and a conventional treatment group (n = 46). Members of the intervention group participated in 12 months of intensified education; those in the conventional group visited local health centers. Compliance with dietary instructions was monitored through food records. Intensified dietary therapy resulted in greater weight loss, better metabolic control, and a less atherogenic lipid profile than conventional treatment. Intake of energy and saturated fatty acids tended to decline in the intervention group. A higher percentage of patients in the intervention group had a total fat intake of 30% of energy or less after 15 months (32.5% [12 of 38] vs 17.4% [8 of 46]). Similarly, more patients in the intervention group had a saturated fatty acid intake of 10% or less of total energy intake at the end of the study (35.0% [13 of 38] vs 8.7% [4 of 46]). The mean dietary cholesterol intake was within recommendations in both groups at the end of the study. The relative percentage of linoleic acid of serum lipids increased significantly and the relative percentage of palmitic acid of serum triglycerides, phospholipids, and cholesterol esters decreased in the intervention group. These changes indicate that intensified dietary therapy improved the quality of fat in the diet of patients with NIDDM.

Calcium intakes of Mexican Americans, Cubans, Puerto Ricans, non-Hispanic whites, and non-Hispanic blacks in the United States

Abstract: Objective To compare dietarty calcium intakes from food in Mexican Americans, Cubans, Puerto Ricans, non-Hispanic whites, and non-Hispanic blacks aged 11 through 74 years. Design Population survey data from the Hispanic Health and Nutrition Examination Survey and the second National Health and Nutrition Examination Survey were used to calculate calcium intake from a single 24-hour recall. These data were compared by age and sex between the five population groups. Food sources of calcium in the three Hispanic groups were also examined using 24-hour recall data. Subjects The sample consisted of 11,773 non-Hispanic whites, 1,728 non-Hispanic blacks, 4,739 Mexican Americans, 1,076 Cubans, and 1,835 Puerto Ricans. Main outcome measures Mean calcium intake, percentage intake of Recommended Dietary Allowance, and, for Hispanics, food sources of calcium. Statistical analyses Means were compared within age and sex groups between the five population group using a t test. Results Calcium intakes from food in three Hispanic groups were similar to intakes of non-Hispanic whites and higher than intakes of non-Hispanic blacks. Although dairy foods were the main sources of calcium for Hispanics, corn tortillas were important calcium sources among Mexican Americans. Women consumed less calcium than the Recommended Dietary Allowance in all age and racial or ethnic groups. Applications When assessing calcium intakes of the three Hispanic groups, ethnic differences in food sources of calcium need to be considered. Efforts to increase calcium intake in Hispanics also need to account for ethnic differences.

Nutrition therapy for hepatic glycogen storage diseases

Abstract: Hepatic glycogen storage diseases (GSD) are a group of rare genetic disorders in which glycogen cannot be metabolized to glucose in the liver because of one of a number of possible enzyme deficiencies along the glycogenolytic pathway. Patients with GSD are usually diagnosed in infancy or early childhood with hypoglycemia, hepatomegaly, poor physical growth, and a deranged biochemical profile. Dietary therapies have been devised to use the available alternative metabolic pathways to compensate for disturbed glycogenolysis in GSD I (glucose-6-phosphatase deficiency), GSD III (debrancher enzyme deficiency), GSD VI (phosphorylase deficiency, which is less common), GSD IX (phosphorylase kinase deficiency), and GSD IV (brancher enzyme deficiency). In GSD I, glucose-6-phosphate cannot be dephosphorylated to free glucose. Managing this condition entails overnight continuous gastric high-carbohydrate feedings; frequent daytime feedings with energy distributed as 65% carbohydrate, 10% to 15% protein, and 25% fat; and supplements of uncooked cornstarch. In GSD III, though glycogenolysis is impeded, gluconeogenesis is enhanced to help maintain endogenous glucose production. In contrast to treatment for GSD I, advocated treatment for GSD III comprises frequent high-protein feedings during the day and a high-protein snack at night; energy is distributed as 45% carbohydrate, 25% protein, and 30% fat. Patients with GSD IV, VI, and IX have benefited from high-protein diets similar to that recommended for patients with GSD III.

Barley bran flour accelerates gastrointestinal transit time

Abstract: The effect of barley bran flour on colon physiology was studied in 44 volunteers. Twenty-two subjects followed the National Cholesterol Education Program (NCEP) step 1 diet supplemented with 20 g cellulose and the other 22 followed the NCEP diet supplemented with 30 g barley bran flour. To measure gastrointestinal transit time, subjects ingested 20 polyethylene pellets impregnated with barium sulfate in two gelatin capsules. Subjects collected fecal samples for 5 days during the baseline period and again during the period of fiber supplementation. Each stool sample was radiographed, and the number of recovered markers was used to calculate mean transit time. Daily fecal weights were recorded and dry weights were determined. The group that consumed barley bran flour significantly decreased transit time by 8.02 hours from baseline, whereas the group that consumed cellulose increased transit time by 2.95 hours from baseline. Similarly, cellulose supplementation did not result in increased fecal weight, whereas daily fecal weight increased significantly by 48.6 g with supplementation with barley bran flour. This study shows that barley bran flour accelerates gastrointestinal transit and increases fecal weight.

Resting energy expenditure in the obese: a cross-validation and comparison of prediction equations.

Abstract: Objective To examine the accuracy and precision of 12 equations or tables for predicting resting metabolic rate (RMR) in obese persons. Design Observational (correlational) study. Setting Obesity Research Center, St Luke's/Roosevelt Hospital, New York, NY. Subjects/samples One hundred twenty-six (73 women, 53 men) healthy, obese subjects recruited through the Obesity Research Center's Weight Control Unit. Measures RMR by indirect calorimetry. Weight and height were measured to the nearest 0.1 kg and to the nearest 1 cm. Statistical analyses performed Bivariate regression of predicted RMR on measured RMR; paired t tests for the difference between means of predicted RMR and measured RMR. Results Of the 12 prediction equations, 6 had intercepts or slopes that were significantly different from 0 and 1, respectively. With two exceptions, the equations accounted for between 56% and 63% of the variance in measured RMR. The Robertson and Reid (1952) equation and the Fleisch (1951) equation performed best with our obese sample. Applications/conclusions The Robertson and Reid (1952) and the Fleisch (1951) equations are recommended for clinical use with obese patients. J Am Diet Assoc. 1993; 93: 1031–1036.

Putting osteoporosis in perspective

Abstract: Osteoporosis is characterized by a reduction in bone mineral density (BMD). Dietary patterns that encourage adequate calcium intake are essential to maximal development and later maintenance of bone mass. The majority of white women are at risk for osteoporosis-related fractures, especially in the wrist, spine, and hip. The degree of fracture risk at a specific bone site is best assessed by measuring BMD with single- or x-ray-photon absorptiometry. BMD in adults of any age is quite variable. Numerous diet and lifestyle factors influence BMD and, in turn, fracture risk. Sufficient evidence exists for a relationship between BMD and diet, particularly calcium and vitamin D; amenorrhea; body weight; alcoholism; smoking; and physical inactivity. Less convincing evidence exists for a relationship with dietary protein, dietary phosphorus, and caffeine intake. To minimize fracture risk, young women should have regular menses, consume a nutritionally adequate diet (according to the principles of the Food Guide Pyramid), perform regular physical activity, only consume a moderate intake of alcohol (if any), and not smoke. Postmenopausal women should follow those same guidelines and should seriously consider estrogen replacement therapy. Elderly persons especially should ensure adequate calcium and vitamin D nutriture. Currently, osteoporosis is the rule, rather than the exception, in old age for many white women. Dietitians can help reduce the prevalence of this disorder.