Pilot implementation of an electronic patient-reported outcome measure for planning and monitoring participation-focused care in early intervention.

BACKGROUND: Family-centered care is a valued approach to improving child and family outcomes in early intervention (EI), yet there is need to implement interventions that support information exchange for shared decision-making when planning and monitoring EI care. This study aims at estimating the feasibility, acceptability, and value of implementing the Young Children's Participation and Environment Measure (YC-PEM), a valid electronic patient-reported outcome (e-PRO) that is designed to support family engagement when planning care and monitoring outcomes of care. METHODS: Data were gathered from caregivers (N = 139) that were enrolled in a Phase 1 trial of the YC-PEM e-PRO as implemented within 1 month of their child's next EI evaluation of progress. YC-PEM e-PRO feasibility was estimated according to enrollment and completion rates, and mean completion time. Chi-square tests were used to examine parent perceptions of YC-PEM e-PRO acceptability by caregiver education and family income. Caregiver feedback via open-ended responses were content coded to inform intervention and protocol optimizations. YC-PEM e-PRO value was estimated via composite and item-level scores to capture the extent of participation difficulty in home and community activities, and common areas of need regarding caregivers desired change in their child's participation. RESULTS: Feasibility of implementing the YC-PEM e-PRO in routine EI care was mixed, as evidenced by low enrollment rates (21.0-29.2%), a high completion rate (85.3%), and limited missing data (80.6% of completed cases contained no missing data). More than half of the participants reported that the completion of the YC-PEM e-PRO was at least somewhat helpful, regardless of family income or caregiver education, providing support for its acceptability. As for its value, the YC-PEM e-PRO results were viewed by 64% of caregivers, whose desire for change most often pertained to the child's participation in non-discretionary activities at home and structured activities in the community. CONCLUSIONS: Results may support the implementation of YC-PEM e-PRO as a feasible, acceptable, and valued option for engaging families in planning the child's EI care. Results also inform select intervention and protocol optimizations prior to undertaking a multi-site pragmatic trial of its effectiveness on family engagement and shared decision-making within an EI clinical workflow. TRIAL REGISTRATION: Trial number: NCT03904797 . Trial registered at Clinicaltrials.gov . Registered 22 March 2019. Retrospectively registered.

Human papillomavirus (HPV) types among Alaska native women attending a colposcopy clinic in Anchorage, Alaska, 2009-2011.

BACKGROUND: The first HPV vaccines licensed targeted two HPV types responsible for most cervical cancers. A 9-valent vaccine (9vHPV), targeting 5 additional types, was introduced in 2016 and is currently the only HPV vaccine available in the United States. Previous studies demonstrated high rates of HPV infection in Alaska Native (AN) women. We sought to measure prevalence of high risk HPV types in AN women undergoing colposcopy and to determine those preventable by vaccination. METHODS: For this cross-sectional study, we recruited women who were undergoing colposcopy for clinical indications at Alaska Native Medical Center to obtain cervical brush biopsy samples. Specimens were shipped to Atlanta, Georgia for DNA extraction, HPV detection, and typing using L1 PCR with type-specific hybridization to detect 37 HPV types. RESULTS: Four hundred eighty eight specimens from 489 women were tested. At least one HPV type was found in 458 (94%) specimens. Of 458 participants who were HPV positive, 332 (72%) had two or more types. At least one type targeted by 9vHPV was detected in 95% of participants with CIN 3 (21/22), 82% with CIN 2 (37/45), and 65% with CIN 1 (119/184). (p < 0.001) HPV 16 or 18 were detected in 77% (17/22) with CIN 3, 53% (24/45) with CIN 2, and 36% (67/184) with CIN 1. (p < 0.001). CONCLUSIONS: A substantial proportion of AN women attending colposcopy clinic had evidence of HPV 16/18 infection, as well as other high risk types targeted by 9vHPV. At least one 9vHPV type was detected in 62% of the participants overall, and 95% of participants with CIN3. AN women are expected to benefit from vaccination against HPV 16/18, and will have greater benefit from 9vHPV. Information from this study could be used to develop public health strategies to increase vaccine uptake, or to track HPV genotype prevalence over time.

Prevalence of diabetes mellitus in Alaskan Eskimos, Indians, and Aleuts.

The prevalence of diabetes mellitus in Alaska Natives has been thought to be low, but no survey of this condition in all natives has been conducted. Medical records from 1979 to 1985 were reviewed to determine the prevalence of diagnosed diabetes mellitus in Alaska Natives. Computerized outpatient and inpatient medical record data and clinician reports were used to identify cases. As of December 1985, 610 living Alaska Natives fulfilled diagnostic criteria for diabetes. Type II diabetes mellitus was found in 564 subjects, type I diabetes was found in 15 subjects, and unspecified type of diabetes was found in 31 subjects. The overall age-adjusted prevalence of diabetes mellitus, 15.7/1000, was lower than the overall United States rate of 24.7/1000. However, age-adjusted prevalence varied considerably by ethnic group; the prevalence was 27.2/1000 among Aleuts, 22.0/1000 among Alaskan Indians, and 8.8/1000 among Alaskan Eskimos. Rates within the Eskimo subgroups varied by a factor of four. Compared with previous reports, the prevalence of diabetes mellitus in Alaskan Eskimos appears to have increased. Diabetes mellitus is no longer a rare condition among Alaska Natives.

Diabetes mellitus in Alaskan Yup'ik Eskimos and Athabascan Indians after 25 yr.

OBJECTIVE: To estimate the prevalence of diabetes mellitus and overweight in two populations of Alaska Natives and to compare the results with previous data. RESEARCH DESIGN AND METHODS: Participants' heights, weights, and random plasma glucose levels were determined. Those with a glucose of greater than or equal to 6.72 mM received a follow-up glucose-tolerance test, interpreted by WHO criteria. Overweight was defined by National Center for Health Statistics criteria and also by criteria used in previous studies. The subjects were Eskimo and Athabascan residents greater than or equal to 40 yr of age in 15 villages in southwestern Alaska. RESULTS: Diabetes prevalence was 4.7% for Eskimos and 10.0% for Indians. Among Eskimo men and women, the prevalence of overweight was 34 and 56%, respectively, among Indian men and women, it was 29 and 55%, respectively. Comparisons with past data indicate that the prevalence of diabetes has increased from 1.7% in 1962 for Eskimos and 1.8% in 1969 for Indians. CONCLUSIONS: The prevalence of diabetes appears to have increased among Eskimos and Indians in Alaska. Overweight appears to be a significant problem in both groups.

Diabetes prevalence, incidence, and complications among Alaska Natives, 1987.

OBJECTIVE: To provide descriptive epidemiological data on diabetes mellitus among Alaska Natives, including incidence, updated prevalence, and incidence rates of ESRD, LEA, MI, and stroke in the diabetic population. RESEARCH DESIGN AND METHODS: In IHS and tribal contract hospitals and clinics throughout Alaska, Alaskan Indians, Eskimos, and Aleuts living in Alaska with documented diabetes mellitus were studied from 1986 to 1987. RESULTS: The number of diabetic patients increased from 610 to 708, and the prevalence changed from 15.7 to 17.4/1000 (not a statistically significant increase). Incidence rates per 10,000 diabetic person-yr for complications were 38 for ESRD, 69 for LEA, 92 for MI, and 92 for stroke. CONCLUSIONS: The prevalence of diabetes mellitus increased during the period of observation, but not to a statistically significant degree. Incidence rates for diabetes are lower than for the U.S. general population, but complications rates are as high as those in other diabetic populations.

Prevalence of diabetes mellitus in pregnancy among Yup'ik Eskimos, 1987-1988.

OBJECTIVE: To evaluate the prevalence of diabetes mellitus in pregnancy in Yup'ik Eskimos. RESEARCH DESIGN AND METHODS: A retrospective review of consecutive birth-log data and medical records was conducted. Records were taken from the primary care and tertiary referral facilities in Alaska Area Native Health Service. Some 630 consecutive deliveries were reviewed from 1 March 1987 to 29 February 1988, with 25 excluded for ancestry other than Alaska Native. Another 605 Alaska Native patient charts were reviewed, with 545 Alaska Native patients screened for diabetes in pregnancy. The study population had a mean age of 25.6 yr, mean gravidity of 3.4, mean parity of 1.9, and mean birth weight of 3567 +/- 493 g. RESULTS: Patients were screened with a 50-g glucose oral load with a plasma glucose 1 h later. 156 of 605 (25.7%) patients, with a screen > or = 7.8 mM received a 100-g OGTT. Of 605, 35 (5.8%) patients met O'Sullivan criteria, and 2 of 605 (0.3%) patients met WHO criteria for previous diabetes mellitus, for a total 37 of 605 (6.7% [corrected]) women with diabetes in pregnancy. The subjects who met O'Sullivan criteria had statistically greater mean age (29.9 yr), gravidity (4.9), parity (2.9), and birth weight of their infants (3678 +/- 389 g), compared with women with a screen < 7.8 mM. CONCLUSIONS: The prevalence of diabetes in pregnancy among Yup'ik Eskimos is twice the rate for the U.S. for all races, despite the Yup'ik having the lowest rate of diabetes mellitus among Alaska Natives. This may represent a large number of undiagnosed patients with impaired glucose tolerance, and may reflect the wide-spread dietary and life-style changes that have occurred in the Yup'ik in the last 30 yr. The Yup'ik present a unique opportunity to apply prevention techniques in a population with an emerging problem with glucose tolerance.

Lower prevalence of impaired glucose tolerance and diabetes associated with daily seal oil or salmon consumption among Alaska Natives.

OBJECTIVE: To examine the association of seal oil and salmon consumption with impaired glucose tolerance (IGT) and non-insulin-dependent diabetes mellitus (NIDDM) among Alaska Natives. RESEARCH DESIGN AND METHODS: Screening was performed on 666 Yup'ik Eskimos and Athabaskan Indians > or = 40 years old in 15 villages. Self-administered questionnaires were used to obtain partial food frequency data. A case was defined as IGT or NIDDM, either newly discovered or known. Newly discovered cases (11 patients with NIDDM and 17 with IGT) were determined by random blood glucose testing followed by a 2-h 75-g oral glucose tolerance test (OGTT) for those with values > or = 6.72 mmol/l or for subjects with unconfirmed histories of glucose intolerance. Known cases included 26 patients with NIDDM and 1 with IGT. Control subjects had random blood glucoses < 6.72 or normal OGTT results. RESULTS: Compared with less-than-daily consumption, both daily seal oil (odds ratio [OR] 0.2, 95% confidence interval [CI] 0.1-0.8) and daily salmon consumption (OR 0.5, CI 0.2-1.1) were associated with a lower prevalence of glucose intolerance, controlling for age, ethnicity, body mass index, and sex. The effects were similar when limited to newly discovered cases: OR 0.3, CI 0.1-1.3 for seal oil and OR 0.4, CI 0.1-1.3 for salmon. Consumption of seal oil at least five times per week was required to reduce risk. CONCLUSIONS: Consumption of seal oil and salmon, high in omega-3 fatty acids, appears to lower the risk of glucose intolerance and is a potentially modifiable risk factor for NIDDM in Alaska Natives.

Food and nutrient intake of Seventh-day Adventist women.

Dietary intake data were collected on Seventh-day Adventist vegetarian and Methodist omnivorous postmenopausal women living in the Los Angeles area: Both groups met the Recommended Dietary Allowances except for zinc, folate, vitamin B-6, and vitamin E. Vegetarians' diets had a somewhat higher nutrient density for folate, thiamin, vitamin C, and vitamin A; lower total fat, saturated fatty acids, and cholesterol; and higher dietary fiber. No correlation between dietary intake and bone mineral content was observed. These findings are compared with those in a study on Oregon vegetarian women.

Dietary zinc intake of low-income pregnant women of Mexican descent.

Zinc intakes of low-income pregnant women of Mexican descent were estimated by the use of 24-hr dietary recalls. Recalls were obtained during the first two trimesters for 344 women and again during the third trimester of pregnancy for 279 of the same women. The daily mean zinc intake was calculated as 9.4 +/- 3.8 mg during the first two trimesters and as 10.0 +/- 4.3 mg during the third trimester. For about 85% of the women, the reported intakes were below two-thirds of the Recommended Dietary Allowance for zinc. In a subsample of the women, no significant correlation was shown between low dietary zinc intakes and low serum zinc levels during either early or late pregnancy. Zinc and protein intakes were highly correlated in both early and late pregnancy (r = 0.83 and 0.89, respectively). Diets that provided 90 to 100 g of protein (about 125% of the Recommended Dietary Allowance) provided a mean of 13.6 g of zinc (67% of the Recommended Dietary Allowance).

Vitamin B-6 nutriture and plasma diamine oxidase activity in pregnant Hispanic teenagers.

Vitamin B-6 status was assessed by measuring erythrocyte glutamic-pyruvic transaminase (EGPT) indices in 122 pregnant Hispanic teenagers. Seventeen percent were vitamin B-6 deficient (EGPT indices greater than 1.25) at the initial interview (first or second trimester). A daily supplement of 5 mg vitamin B-6, beginning at initial interview, did not reduce prevalence of vitamin B-6 deficiency at final interview (third trimester). No association was found between EGPT indices greater than 1.25 and the outcome of pregnancy. The activity of diamine oxidase (DAO), a vitamin B-6-dependent enzyme produced by the placental decidua, was measured in maternal plasma. At initial and final interviews, plasma-DAO activity was increased by in vitro addition of pyridoxal-5'-phosphate. The activity in early pregnancy was positively associated with dietary vitamin B-6 intake and was lower in teenagers with EGPT indices greater than 1.25 at the final interview. Findings suggest that plasma-DAO activity is influenced by vitamin B-6 status.

Bone mineral content in postmenopausal women: comparison of omnivores and vegetarians.

This cross-sectional study of bone mineral content (BMC)/bone width (BW) (BMC/BW, cortical radius) was conducted in elderly, free-living Methodist omnivores (n = 146) and Seventh-day Adventist vegetarians (n = 144) in southern California. The purpose was to investigate relationships between BMC/BW and dietary factors (primarily vegetarianism and intakes of protein and calcium) and use of prescribed drugs. BMC was measured by single-photon absorptiometry. Dietary intakes during current and early periods of life were assessed by 24-h dietary recall and frequency methods. Information about drug use was obtained by interview. BMC/BW was not different in omnivores vs vegetarians. There were no significant relationships or trends between current or early dietary intakes and BMC/BW in either group. In multiple-regression analysis, age, weight, and use of estrogen and thiazide diuretics were predictive of 31% of the variability in BMC/BW in the total group.

Zinc, vitamin B-6, and other nutrients in pregnant women attending prenatal clinics in Mexico.

Biochemical measurements and 24-h dietary recalls were conducted early (18.9 +/- 5.9 wk) and late (35.1 +/- 2.0 wk) in pregnancy in women attending clinics in Montemorelos, Mexico. Mean weight gain per week (0.4 +/- 0.2 kg) and birth weight (3381 +/- 456 g) were normal. Intakes tended to decline during pregnancy and declined significantly for zinc (p less than 0.05) and vitamin B-6 (p less than 0.03). Mean Zn intake late in pregnancy was low (7.8 +/- 3.3 mg/d). Various supplements were taken but none contained Zn. During pregnancy mean plasma Zn levels fell (p less than 0.001) and late in pregnancy 57% of the women had values suggestive of poor Zn status (less than or equal to 8.1 mumol/L). These data indicate that Zn intakes of approximately 8 mg/d will not maintain plasma Zn levels in late pregnancy. Erythrocyte glutamic-pyruvic transaminase (EGPT) index and the index of diamine oxidase (DAO), a vitamin B-6-requiring enzyme of placental origin, were correlated suggesting that DAO index may be useful in evaluating vitamin B-6 status in pregnancy.

PIP: Biochemical measurements and 24 hour dietary recalls were conducted early (18.9 +0- 5.9 weeks) and late (35.1 +or- 2.0 weeks) in pregnancy in women attending clinics in Montemorelos, Mexico. Mean weight gain per week (0.4 +or- 0.2 kg) and birth weight (3381 +or- 456 grams) were normal. Intakes tended to decline during pregnancy and declined significantly for zinc (p 0.05) and vitamin B-6 (p 0.03). Mean zinc intake late in pregnancy was low (7.8 +or- 3.3 mg/d). Various supplements were taken but none contained zinc. During pregnancy mean plasma zinc levels fell (p 0.001) and late in pregnancy 57% of the women had values suggestive of poor zinc status (or= 8.1 micromoles/liter). These data indicate that zinc intakes of approximately 8 mg/d will not maintain plasma zinc levels in late pregnancy. Erythrocyte glutamic-pyruvic transaminase (EGPT) index and the index of diamine oxidase (DAO), a vitamin B-6-requiring enzyme of placental origin, were correlated suggesting that DAO index may be useful in evaluating vitamin B-6 status in pregnancy.

Zinc supplementation during pregnancy: effects on selected blood constituents and on progress and outcome of pregnancy in low-income women of Mexican descent.

The effects of zinc supplementation on levels of various blood constituents and the outcome of pregnancy in 213 Hispanic women attending a prenatal clinic in Los Angeles was assessed in this double-blind study. The women were randomized into either a control (C) or a zinc-supplemented (Z) group and received similar vitamin and mineral supplements except that 20 mg zinc was added to the Z group's capsules. At the final interview, women (C + Z) with low serum Zn levels (less than or equal to 53 micrograms/dl) had higher (p less than 0.01) mean ribonuclease activity and lower (p less than 0.01) mean delta-aminolevulinic acid dehydratase activity than women with acceptable serum zinc levels. The incidence of pregnancy-induced hypertension was higher (p less than 0.003) in the C than in the Z group, but pregnancy-induced hypertension was not associated with low serum zinc levels at either the initial or final interview. The expected increase in serum copper levels was greater (less than 0.001) in women with pregnancy-induced hypertension (C + Z) than in normotensives. Except for pregnancy-induced hypertension, there was a higher incidence of abnormal outcomes of pregnancy in the noncompliers than in the compliers (C + Z).

Zinc supplementation during pregnancy in low-income teenagers of Mexican descent: effects on selected blood constituents and on progress and outcome of pregnancy.

As a follow-up of our study of pregnant women, we report effects of zinc supplementation during pregnancy in another population of 138 Hispanic teenagers in Los Angeles. Teenagers were randomized (double-blind) to a control or zinc-supplemented group and received similar daily vitamin and mineral supplements except for 20 mg zinc added to the zinc-supplemented group's capsules. Initially, mean dietary zinc intakes of both groups were about 50% of the Recommended Dietary Allowance and their mean serum zinc levels did not differ significantly (69.8 +/- 11.2 micrograms/dl in control and 69.0 +/- 11.4 micrograms/dl in zinc-supplemented group). Zinc supplementation did not maintain mean serum zinc levels during pregnancy but, as in our earlier study, it reduced (p = 0.018) the number of low serum zinc values (less than or equal to 53 micrograms/dl) in late pregnancy. Zinc supplementation did not affect outcome of pregnancy but serum zinc levels were lower (p = 0.038) in teenagers with pregnancy-induced hypertension than in normotensives.

Zinc supplementation during pregnancy: zinc concentration of serum and hair from low-income women of Mexican descent.

The effect of zinc supplementation on concentrations of zinc in hair and serum of 213 pregnant Hispanic women attending a clinic in Los Angeles was assessed using a random, double-blind experiment. Both the treatment (T) and control (C) groups received similar vitamin and mineral supplements except that 20 mg zinc was added to the supplements for the treatment group. Nutrient intakes were calculated from 24-h recalls. The initial mean dietary zinc intake of both groups was about 50% of the Recommended Dietary Allowance (9 +/- 5 mg). Initially there were no significant differences between the two groups in mean zinc levels in serum (66 +/- 11 micrograms/dl, C, and 65 +/- 12 micrograms/dl, T) or in hair (184 +/- 41 micrograms/g, C, and 175 +/- 38 micrograms/g, T). Zinc supplementation did not alter mean zinc levels in serum or hair but significantly (p less than 0.05) reduced the number of low serum zinc values (less than or equal to 53.3 micrograms/dl) toward the end of pregnancy. Although serum zinc levels do decline in pregnancy, our results suggest that severely depressed levels (less than or equal to 50 to 55 micrograms/dl) indicate inadequate zinc status.

Screening for gestational diabetes mellitus with a reflectance photometer: accuracy and precision of the single-operator model.

OBJECTIVE: To investigate the accuracy and precision of a recent-generation reflectance photometer, Accu-Chek III, for gestational diabetes mellitus screening with a single operator. METHODS: Four hundred ten paired capillary and serum glucose samples collected prospectively were evaluated by a reflectance photometer and a glucose oxidase method (Beckman), respectively, during routine gestational diabetes mellitus screening with a single operator. RESULTS: The mean Accu-Chek III result was 12% greater than serum glucose oxidase (115.5 +/- 1.4 and 103.4 +/- 1.3 mg/dL, respectively). A serum glucose level of at least 135 mg/dL by glucose oxidase produced sensitivity and specificity of 0.81 and 0.68, respectively. At 155 mg/dL, the Accu-Chek III sensitivity was 0.81 and specificity 0.74, and the method produced fewer false-positive results (37 of 410 [9.0%] versus 41 of 410 [10%]) than a 135-mg/dL serum cutoff. Adjusting the Accu-Chek III threshold by two times the coefficient of variation resulted in the same number of false positives as the Beckman technique at 135 mg/dL. The receiver operating characteristic curve cutoff for the venous value of 135 mg/dL was an Accu-Chek III value of 141 mg/dL. Linear regression analysis predicted y = 20.6 + 0.919x, r = 0.838. The mean coefficient of variation was 3.9%. CONCLUSIONS: The Accu-Chek III produced accurate and precise gestational diabetes mellitus screening results with a single operator. Because capillary blood is a combination of arterial and venous blood, an Accu-Chek III cutoff of 155 mg/dL may be more appropriate for screening, considering the 10-15% higher capillary glucose level in the fed state. An Accu-Chek III cutoff of 155 mg/dL produced a higher specificity than venous serum at 135 mg/dL, with no decrease in sensitivity.

Identifying a limited number of foods important in supplying selected dietary nutrients.

Three methods were developed to identify a limited number of foods that are important dietary contributors of fat, dietary fiber, and vitamins A, C, and E. In the first method, foods were ranked by the amount of each nutrient supplied per person per day and the effect each food had on the relative ranking of individuals with respect to the intake of those nutrients. Foods scoring high on both scales for a given nutrient were selected as important dietary contributors of that nutrient. In the second method, foods were selected according to the mean nutrient contribution per consumer (nonconsumers of a food were eliminated from this estimation procedure). In the third method, foods were selected that contributed a relatively large percentage of the total dietary intake of a given nutrient. The three methods were applied to data from an extensive dietary questionnaire. The authors then compared the limited lists of foods identified by each method. Generally, the methods yielded similar food lists. Regression analysis was then employed to test the ability of the selected foods to predict the nutrient totals calculated from the original, more extensive dietary questionnaire. The results suggest that a limited number of foods may have strong predictive ability, but that has not been tested in any other population.

Nutrient estimates from computerized questionnaires vs. 24-hr. recall interviews.

A computerized nutritional assessment service used by dentists was investigated. Daily nutrient intake of forty-six adult subjects was estimated from replies to a computerized food frequency questionnaire and the results compared with the average nutrient intakes of the same individuals obtained during five 24-hr. dietary recall interviews. Although the two methods produced essentially the same mean for carbohydrate intake and a minimal difference in the mean caloric values, mean estimates of the other nutrients were 6 to 88 per cent greater with the computerized data than via the dietary recalls. The dietary assessment service included unwarranted recommendations for vitamin and mineral supplementation.

Dietary change and obesity associated with glucose intolerance in Alaska Natives.

OBJECTIVE: To investigate frequency of food intake, body weight, and glucose intolerance in Alaska Natives. DESIGN: Height, weight, and random blood glucose levels were measured and a frequency-of-food-intake questionnaire was obtained. This questionnaire classified persons as consumers of indigenous foods or nonindigenous foods within three food groups. Those with a random blood glucose measurement > or = 6.72 mmol/L received an oral glucose tolerance test. SETTING: Community screening in 15 villages in Alaska. SUBJECTS: Nutrition screenings were done for 1,124 Alaska Native residents aged 20 years or older. An oral glucose tolerance test was done for 202 subjects. OUTCOMES MEASURED: Subjects were classified as consumers of indigenous or nonindigenous foods within three food groups. A diagnosis of non-insulin-dependent diabetes mellitus (NIDDM) was made on the basis of World Health Organization criteria. A determination of overweight was made on the basis of National Center for Health Statistics criteria. STATISTICAL ANALYSIS: A chi 2 test with Yates correction, t test, and linear regression, with two-sided P values. RESULTS: Athabascan Indians had twice the rate of NIDDM as Yup'ik Eskimos with significantly higher frequency of nonindigenous food intake, plus lower frequency of indigenous carbohydrate and fat intake. Subjects < or = 30 years old consumed significantly more nonindigenous protein and fat and low-nutrient-density carbohydrates than those > or = 60 years old. Persons who had glucose intolerance reported significantly greater consumption of nonindigenous protein and less seal oil. Incidence of overweight was significantly higher than was found 25 years ago. Participants with glucose intolerance were significantly more overweight than others. CONCLUSION: A pattern of increased frequency of nonindigenous protein, low-nutrient-density carbohydrate, and fat intake with less indigenous carbohydrate and fat consumption was found in subjects < or = 30 years old and in association with the higher rate of NIDDM found in the Athabascan Indians. Persons with glucose intolerance were significantly more overweight than others. APPLICATIONS: Although the nutritional value of indigenous foods for reducing disease risk should be promoted, nutrition education, especially among young adults, should also include building skills to select and prepare nonindigenous foods to attain a healthful diet. Although snacking is a concern, dietary fat was the most significant factor in obesity and NIDDM.

Carbohydrate sources for gestational diabetes mellitus screening. A comparison.

One hundred eight patients were prospectively randomized to receive 50 g of a glucose polymer, d-glucose or a candy bar during a one-hour gestational diabetes mellitus (GDM) screening. The polymer had a mean serum glucose similar to that of d-glucose, with significantly fewer side effects, allowing an increased rate of examination completion. The candy bar produced a significantly lower mean serum glucose but had the highest rating for flavor. The polymer was an inexpensive and well-tolerated alternative for GDM screening, while the use of a candy bar needs more study.