Association of awareness, intrapersonal and interpersonal factors, and stage of dietary change with fruit and vegetable consumption: a national survey.

PURPOSE: To examine associations of awareness, intrapersonal and interpersonal factors, and stage of change with consumption of fruits and vegetables. DESIGN: Nationally representative, random digit dial survey conducted in 1997 with a response rate of 44.5%. Psychosocial correlates of fruit and vegetable consumption were assessed using regression analyses. SETTING: United States. SUBJECTS: A total of 2605 adults who were 18 years and older. MEASURES: Awareness of the "5 A Day for Better Health" program and its message, along with stage of change; taste preferences; self-efficacy; and perceived benefits, barriers, threats, social support, and norms related to fruit and vegetable consumption. RESULTS: Awareness and intrapersonal and interpersonal factors explained 24% of the variance in fruit and vegetable consumption beyond the 9% explained by demographic characteristics. Knowledge of the 5 A Day message was associated with a 22% increase in fruit and vegetable consumption. Self-efficacy for eating fruits and vegetables and taste preferences (affect) were the factors most consistently and strongly associated with both higher consumption and higher likelihood of being in action or maintenance stages of change. Affect and perceived barriers were more strongly associated with increased vegetables and salad than fruit. CONCLUSIONS: Dietary intervention programs to increase fruit and vegetable consumption should emphasize the 5 A Day message, increased self-efficacy, and ways to make vegetables more palatable and easily accessible. Understanding the factors that influence dietary choices should be used when designing dietary interventions.

Overview of the health benefits of fruit and vegetable consumption for the dietetics professional: selected literature.

Epidemiologic evidence of a protective role for fruits and vegetables in cancer prevention is substantial. The strength of this scientific base guides US national policymaking in diet and health issues and facilitates community and local programs that address national dietary goals to increase fruit and vegetable consumption. Current scientific evidence also suggests a protective role for fruits and vegetables in prevention of coronary heart disease, and evidence is accumulating for a protective role in stroke. In addition, a new scientific base is emerging to support a protective role for fruits and vegetables in prevention of cataract formation, chronic obstructive pulmonary disease, diverticulosis, and possibly, hypertension. This article provides an overview of the health benefits associated with fruit and vegetable consumption for each of these conditions, including brief discussions of underlying protective mechanisms, identifies key scientific findings regarding the health benefits of fruit and vegetable consumption, and outlines applications of these findings for dietetics professionals. The evidence reviewed provides additional support for increased consumption of a wide variety of vegetables, in particular, dark-green leafy, cruciferous, and deep-yellow-orange ones, and a wide variety of fruits, in particular, citrus and deep-yellow-orange ones. Continued attention to increasing fruit and vegetable consumption is a practical and important way to optimize nutrition to reduce disease risk and maximize good health.

The national 5 A Day for Better Health Program: a large-scale nutrition intervention.

As cancer gains on heart disease as the leading cause of death, there is increased urgency to improve the current diet that contributes to 35 percent of cancer deaths. Lacking have been consensus about the strength of the science base, political will, resources, and conceptualization about what can be done in communities to change dietary behaviors. Over the past 10 years, the 5 A Day for Better Health Program has emerged as the major population-based initiative for nutrition and cancer prevention. The 5 A Day Program is a national theory-based program that approaches Americans with a simple, positive message: eat five or more servings of fruit and vegetables daily as part of a low-fat, high-fiber diet. This article describes the elements and theories woven into the national 5 A Day Program, provides a description of the important components of the program, and outlines the issues that will face dietary change initiatives in the future.

Dietary behavior change: the challenge of recasting the role of fruit and vegetables in the American diet.

We present an overview of national trends in fruit and vegetable intake and background information on the development of the 5 a Day for Better Health program; which is a national social marketing program created in 1991 to promote consumption by Americans of five or more servings of fruit and vegetables daily. Using the 5 a Day program as an example, we highlight the importance of moving beyond consumption data when approaching a population with a message about healthy eating. In doing so, we incorporate the assessment of marketing data and employ behavioral change theories that are important in modifying behavior. Finally, drawing from the dietary themes of the Mediterranean diet, we propose a new strategy that builds on the good taste and attractiveness of fruit and vegetables, in combination with a health message as a way for health promotion professionals to enhance the role of fruit and vegetables in American cuisine and to help move Americans toward increased fruit and vegetable consumption.

Acceptability of selected low-protein products for use in a potential diet therapy for chronic renal failure.

A very-low-protein, low-phosphorus diet, supplemented with either amino acids or ketoacids, is being studied as a potential therapy for chronic renal failure. Because of the severity of the protein restriction in this dietary approach, maintenance of adequate caloric intake is a concern. Acceptability of 27 low-protein products for potential use as sources of calories in the diet was evaluated. Twenty-three dietitians judged the products on the bases of appearance, taste, texture, and overall acceptability, using a scale of 1 (unacceptable) to 5 (highly acceptable). Sixty-seven percent of the products tested received scores of more than 2.5 in all categories. Products receiving the highest scores were vanilla cream wafers (4.0), low-protein gelatin (3.97), and chocolate chip cookies (3.78). Differences in calories and protein between brands of similar products are minimal; unfortunately, phosphorus and calcium data are lacking for many products. Cost in cents per calorie is 2 to 10 times greater than in conventional foods of the same type. The results show that there are a number of acceptable low-protein products that can be used to help ensure adequate energy intakes without sacrificing protein restriction in this dietary approach for chronic renal failure.

Nutritional risk of high-carbohydrate, guar gum dietary supplementation in non-insulin-dependent diabetes mellitus.

Dietary supplementation with high-carbohydrate, guar gum fiber (HCF) is effective in acutely blunting postprandial blood glucose levels. We report the effect of such supplementation on the diet and nutritional status of a group of 16 subjects with non-insulin-dependent diabetes mellitus (NIDDM) who incorporated either HCF bars (35.7 g carbohydrate and 6.6 g guar gum/bar) or placebo bars (identical except for the absence of guar gum) into the diet for 6 mo as part of a double-blind, randomized clinical trial. The HCF subjects achieved mean daily intake of 4.8 +/- 0.4 bars, constituting 51.2 +/- 3.1% of total calories and providing 29.7 +/- 2.6 g guar gum daily. Energy intakes and body weight did not change significantly in either group. Food consumption patterns and nutrient intakes did change, although not enough to impair the nutritional integrity of the diet because the bars themselves served as a source of nutrients. The bars were rich in thiamin, B6, folacin, phosphorus, iron, zinc, and copper, adequately replacing any decrease in nutrient intake as a result of foods being dropped from the diet. In fact, daily intakes of B6, folacin, and copper actually increased due to contributions from the bars. Nutrients in which the bars were poor (vitamins A, C and B12) resulted in suboptimal intakes (less than 66% RDA). Although no significant change in nutritional status of the HCF group occurred as determined by arm muscle area, arm fat area, hemoglobin, hematocrit, or serum albumin, transferrin, iron, ferritin, calcium, phosphate, B12, and magnesium levels, these indicators of nutritional status are rather insensitive.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term effects of guar gum on blood lipids.

While guar gum has been shown to lower total cholesterol and low density lipoprotein cholesterol (LDL-C) in diabetic patients over the short-term, the long-term effects are less well studied and may be unpredictable. Granola bars with and without 6.6 g guar gum were developed and fed to 16 adult volunteers with Type II diabetes mellitus who had been randomized in a double-blind fashion into guar and placebo groups of equal size. Four to six bars were consumed daily with an ad lib diet over a 6-month period. Total cholesterol, total high density lipoprotein cholesterol (HDL-C), subfractions HDL2-C and HDL3-C, LDL-C, and beta-apoprotein were measured at 0 and 6 months. Although LDL-C was lower and triglycerides higher at 6 months than at baseline, these changes were of equal magnitude and direction in both guar and placebo groups. Using each subject as his own control, only the change in triglycerides was statistically significant (P less than 0.025). When male subjects alone were analyzed, the guar group showed a statistically significant decrease in LDL, while the placebo group did not. Other lipid parameters were not significantly changed during the study, despite a positive effect on carbohydrate metabolism from the guar bars. The data suggest either that the hypolipemic effects of guar gum in patients with Type II diabetes mellitus are not sustained for 6 months, or the effects occur only in men.

Effect of parenteral amino acid supplementation in alcoholic hepatitis.

A controlled randomized study was performed in 15 patients with biopsy-proven alcoholic hepatitis to determine the effect of the administration of a parenteral amino acid-glucose solution for 1 month on nutritional, clinical, biochemical and histological parameters. All patients were allowed ad libitum consumption of a hospital diet. Five patients received the amino acid-glucose solution, while 10 received the glucose solution without amino acids. There was more improvement in nitrogen balance in the treated group than the control group. However, amino acid therapy was no more beneficial than control therapy in improving creatinine-height index, arm muscle area, arm fat area, and plasma levels of retinol binding proteins, prealbumin and pyridoxal-5'-phosphate. Clinical and biochemical markers of liver disease improved in both groups. This improvement in composite clinical index was more rapid in the treated than in the control group, but this early advantage was no longer apparent at the end of one month. Hepatocellular necrosis, inflammation and fat improved in the entire group. Amino acid treatment resulted in a greater resolution of fatty infiltration, but did not otherwise affect hepatic histology. Hepatocellular necrosis and inflammation in both the initial and final liver biopsies were highly correlated with nitrogen balance on admission. Initial clinical index correlated with the quantity of ethanol consumption prior to admission but not with liver injury on biopsy. However, by the end of the study, clinical index correlated with hepatocellular necrosis and inflammation.(ABSTRACT TRUNCATED AT 250 WORDS)

The design of a diet restricted in saturated very long-chain fatty acids: therapeutic application in adrenoleukodystrophy.

Adrenoleukodystrophy is an inherited, progressive disorder of the CNS white matter and adrenal glands, associated with the pathognomonic accumulation of saturated very long-chain fatty acids, particularly C26:0. It has been previously demonstrated that the fatty acids that accumulate in adrenoleukodystrophy are, at least in part, of dietary origin. This observation, coupled with success of dietary phytanic acid restriction in a related disorder, Refsum's disease, encouraged us to develop a diet that would restrict dietary C26:0 intake. We report here the very long-chain fatty acids content of 135 common foods and development of a diet that restricts C26:0 intake to 3 mg, compared to 12 to 40 mg in the standard American diet. To limit C26:0 intakes it was found necessary to restrict fatty foods and the outer coverings of vegetables and fruits. In contrast to the success of phytanic acid restriction in limiting disease progress in Refsum's patients, administration of the very long-chain fatty acid-restricted diet to seven adrenoleukodystrophy patients for 3- to 24-month periods was found to be ineffective in lowering their plasma very long-chain fatty acids or in improving clinical status. Recently endogenous synthesis of C26:0 has been demonstrated and this may account for the failure of dietary therapy in adrenoleukodystrophy. It is possible that dietary restriction may augment other therapies in the future.

The relationship between oral-motor involvement and growth: a pilot study in a pediatric population with cerebral palsy.

Growth retardation in the pediatric cerebral palsy population has been well documented in the literature. No attempt had been made to examine the extent to which this growth retardation is affected by the presence or absence of oral-motor dysfunction. In our retrospective pilot study, the growth of 12 children (8 girls, 4 boys) with cerebral palsy and oral-motor impairment was compared with the growth of an age- and sex-matched control group of 12 children with cerebral palsy but no oral-motor impairment. The growth parameters examined were weight for age, height for age, and weight for height. Data analysis used both the actual measurements and Z scores. Comparisons were made not only between groups but also with NCHS standards at the 50th percentile for specific age and sex. Results indicated that children with oral-motor impairment had depressed weight for age (Z score, p = .002) and height (Z score, p = .049) and depressed height for age (Z score, p = .055). These results suggest a previously undocumented relationship between oral-motor impairment and growth retardation.

Relationship between pyridoxal 5'-phosphate deficiency and aminotransferase levels in alcoholic hepatitis.

The relationship between pyridoxal phosphate deficiency and activities of serum and liver aminotransferases was studied in 12 patients with alcoholic hepatitis. Plasma pyridoxal phosphate and the activities of liver aminotransferases were initially decreased in the patients, as compared with mean values in controls with normal hepatic histology. Addition of pyridoxal phosphate to liver homogenates increased liver alanine aminotransferase, but not aspartate aminotransferase, in all patients with initially low plasma pyridoxal phosphate. After 1 mo of abstinence from alcohol, with intake of an adequate diet and pyridoxine supplementation, plasma pyridoxal phosphate increased in all patients with initially low values (p less than 0.02). Serum aspartate aminotransferase decreased, whereas serum alanine aminotransferase increased, resulting in a decrease in their ratio in serum (p less than 0.001). Liver alanine aminotransferase increased (p less than 0.005), whereas liver aspartate aminotransferase remained unchanged. These data suggest that pyridoxal 5'-phosphate depletion is partially responsible for the low serum alanine to aspartate aminotransferase ratio that is typical of patients with alcoholic hepatitis.