Use of platelet-rich plasma in periodontal surgery--a prospective randomised double blind clinical trial.

The aim of this prospective controlled randomized clinical trial was to evaluate the additional effect of platelet-rich plasma (PRP) in attachment gain. Twenty-two patients showing contralateral intrabony defects were included. Defects were randomized to beta-TCP (Cerasorb) in combination with PRP (test) or alone (control). Probing pocket depth (PPD), clinical attachment level (CAL), and relative AL (RAL) were assessed at the first, initial, re-evaluation (or basis examinations) and 6 months after surgery. Defect dimensions were recorded at baseline surgery (day 0) and during re-entry surgery (after 6 months), with vertical depth of the defect as primary outcome variable. An early healing index (EHI) was assessed 3 days, 1, 2 and 4 weeks after surgery. Both treatments led to clinical improvements. The median reduction of open vertical depth was 1.9 mm (interquartile intervals, 0.75 and 2.5 mm) at test sites, compared with 2.6 mm (1.8 and 3.5 mm) at control sites (p = 0.19, Wilcoxon). The median reductions of PPD and CAL at the four sites in close proximity to the defect in the interproximal area at test sites were 0.8 and 0.28 mm, and at control sites 0.4 and 0.13 mm, respectively. The EHI showed a reduction from grade 3 after 3 days to grade 1 after 4 weeks. PRP did not improve the results achieved with beta-TCP in the treatment of intrabony defects.

Alcohol intake and ovarian cancer risk: a pooled analysis of 10 cohort studies.

Alcohol has been hypothesized to promote ovarian carcinogenesis by its potential to increase circulating levels of estrogen and other hormones; through its oxidation byproduct, acetaldehyde, which may act as a cocarcinogen; and by depletion of folate and other nutrients. Case-control and cohort studies have reported conflicting results relating alcohol intake to ovarian cancer risk. We conducted a pooled analysis of the primary data from ten prospective cohort studies. The analysis included 529 638 women among whom 2001 incident epithelial ovarian cases were documented. After study-specific relative risks (RR) and 95% confidence intervals (CI) were calculated by Cox proportional hazards models, and then were pooled using a random effects model; no associations were observed for intakes of total alcohol (pooled multivariate RR=1.12, 95% CI 0.86-1.44 comparing > or =30 to 0 g day(-1) of alcohol) or alcohol from wine, beer or spirits and ovarian cancer risk. The association with alcohol consumption was not modified by oral contraceptive use, hormone replacement therapy, parity, menopausal status, folate intake, body mass index, or smoking. Associations for endometrioid, mucinous, and serous ovarian cancer were similar to the overall findings. This pooled analysis does not support an association between moderate alcohol intake and ovarian cancer risk.

Vitamin A intake and the risk of hip fracture in postmenopausal women: the Iowa Women's Health Study.

Excessive intake of vitamin A is postulated to have a detrimental effect on bone by inducing osteoporosis. This may lead to an increased risk of fracture, particularly in persons who are already at risk of osteoporosis. However, few studies have specifically examined the association of vitamin A intake through diet and supplement use, with fractures in a cohort of older, community-dwelling women. We prospectively followed a cohort of 34,703 postmenopausal women from the Iowa Women's Health Study to determine if high levels of vitamin A and retinol intake through food and supplement use were associated with an increased risk of hip or all fractures. A semiquantitative food frequency questionnaire was used to obtain the participants' baseline vitamin A and retinol intake. Participants were followed for a mean duration of 9.5 years for incident self-reported hip and nonhip fractures. After multivariate adjustment, it was revealed that users of supplements containing vitamin A had a 1.18-fold increased risk of incident hip fracture (n = 525) compared with nonusers (95% CI, 0.99 to 1.41), but there was no evidence of an increased risk of all fractures (n = 6,502) among supplement users. There was also no evidence of a dose-response relationship in hip fracture risk with increasing amounts of vitamin A or retinol from supplements. Furthermore, our results showed no association between vitamin A or retinol intake from food and supplements, or food only, and the risk of hip or all fractures. In conclusion, we found little evidence of an increased risk of hip or all fractures with higher intakes of vitamin A or retinol among a cohort of older, postmenopausal women.

Dietary catechins in relation to coronary heart disease death among postmenopausal women.

Catechins, one of the major groups of flavonoids, are bioactive compounds present in a variety of plant foods and beverages. Experimental data suggest that they might prevent chronic diseases in humans. We studied whether the intake of catechins was inversely associated with the risk of coronary heart disease death in a prospective study of postmenopausal women from Iowa. Between 1986 and 1998, 767 of 34,492 participants initially free of cardiovascular diseases died from coronary heart disease. There was a strong inverse association between the intake of (+)-catechin and (-)-epicatechin and coronary heart disease death, which was somewhat attenuated after multivariate adjustment (risk ratios from lowest to highest quintile: 1.00, 0.95, 0.97, 0.77, 0.76). This inverse association was most pronounced in women at low risk of coronary heart disease (non-smokers, free of diabetes mellitus and cardiovascular diseases). A high intake of "gallates," catechins typical of tea, was not associated with coronary heart disease death. Of the major catechin sources, apples and wine were inversely associated with coronary heart disease death. Our data suggest that preventive effects might be limited to certain types of catechins, or that these are indicators of other dietary components or a healthy lifestyle in general.

Effect of health lifestyle pattern on dietary change.

PURPOSE: To examine the effect of lifestyle on the effectiveness of a low-intensity dietary intervention. DESIGN: A secondary data analysis was performed using data from the Eating Patterns Study, a randomized controlled trial that found that self-help materials with physician advice was effective in changing dietary intake and behavior. SETTING: Primary care clinics in a large health maintenance organization. SUBJECTS: A total of 2111 patients with a routine scheduled appointment with their primary care physicians. MEASURES: Participants were grouped into one of six health lifestyle patterns based on similarities in baseline measures of alcohol intake, smoking, diet quality, and exercise. Within each lifestyle pattern, changes from baseline in usual fat and fiber intake (based on a food frequency) and a fat and fiber behavior score were compared at 3 months and 12 months for intervention vs. control participants. INTERVENTION: Self-help materials delivered by a physician with advice to change diet. RESULTS: Intervention participants in the fitness lifestyle group made the largest changes relative to controls for each dietary outcome at 3 and 12 months. For intervention participants defined by their alcohol intake or current smoking, either no changes in diet were observed compared with controls, or early changes were not sustained over time. Intervention-control comparisons within the remaining lifestyle patterns showed smaller dietary changes compared with the fitness lifestyle. This finding was similar to previously published results. CONCLUSIONS: This randomized controlled trial had limited power to detect subgroup differences; however, these results suggest that lifestyle patterns may be useful in the development of effective, targeted interventions to change behavior.

Nutritional assessment of pregnant women enrolled in the Special Supplemental Program for Women, Infants, and Children (WIC).

OBJECTIVE: To evaluate nutrient intake from dietary sources for 95 pregnant women enrolled in the Special Supplemental Program for Women, Infants, and Children (WIC). SUBJECTS/SETTING: Women were recruited from Minneapolis and St Paul area WIC clinics between January and June 1999. Based on estimates from the WIC clinics, the study was described to 159 (63%) of the 251 potentially eligible women. Of these 159 women, 107 (67%) completed the in-person interview. Ninety-five (89%) were included in the nutrition analysis. METHODS: Each woman completed a 1-hour in-person interview that included a questionnaire, anthropometric measurements, and a venous blood sample. A shortened Block 98 food frequency questionnaire was used to assess dietary intake. Serum ferritin was measured for 86 women. Means, medians, and standard deviations of dietary intake were explored as well as body mass index distributions. Additionally, the percentage of women consuming less than two thirds of the recommended dietary allowance (RDA) for certain nutrients was calculated. RESULTS: Overall, the women reported consuming only 85% of the RDA for energy. The average percentage of energy from fat was higher than recommended (37% vs 30%). The most notable nutrient shortfall was iron; 90% of the women reported consuming less than 2/3 of the RDA. Additionally, serum ferritin analysis classified 22% of the women with iron-deficiency anemia (<12 mg/L). CONCLUSIONS: Interventions should be designed to decrease fat consumption and increase iron intake among pregnant WIC participants to meet dietary recommendations.

Prevalence of use of herbal products by adults in the Minneapolis/St Paul, Minn, metropolitan area.

OBJECTIVES: To document the prevalence of use of herbal products among adults in a large metropolitan area and to examine issues surrounding such use. SUBJECTS AND METHODS: Of people aged 18 years and older residing in the Minneapolis/St Paul, Minn, metropolitan area, 752 were randomly selected from Minnesota Department of Public Safety Driver and Vehicle Service Division data tapes. Between June and August 1999, surveys were mailed to determine use of any herb and use of 13 specific herbs. Rationale for use, perceived efficacy, and source of product information were assessed for each of the specific herbs. RESULTS: Of the initial 752 persons, 580 were eligible, and 376 returned a completed survey, resulting in a response rate of 65%. When asked whether they had used an herb during the past 12 months, 230 respondents (61.2%) reported that they had. Prevalence of use of specific herbs ranged from 30.9% for ginseng to 3.0% for milk thistle. The most commonly reported reasons for using herbs varied by the type of herb, although for 5 of the herbs, the most frequently mentioned reason was to promote general health/well-being. For 11 of the 13 herbs, less than 60% of those who used the herb rated it as effective or very effective. Family, friends, and written materials were the leading sources of product information among those taking 9 of the 13 specific herbs. CONCLUSIONS: Herbs are used frequently to treat or prevent an array of health conditions. At present, people who use herbal products appear to rely predominantly on family and friends for information.

Patterns of physical activity among American Indian children: an assessment of barriers and support.

Estimates indicate that 10% to 50% of American Indian and non-Indian children in the U.S. are obese, defined as a body mass index > or = 95th percentile of the NHANES II reference data. Pathways is a two-phase, multi-site study to develop and test a school-based obesity prevention program in American Indian schoolchildren in grades three through five. During Phase I feasibility prior to initiation of the Pathways trial, data were collected related to physical activity patterns, and the supports of, and barriers to, physical activity. Nine schools from communities representing six different tribal groups participated in this study. Multiple measures were used for data collection including direct observation, paired child interviews, and in-depth interviews and focus groups with adults. Students completed the self-administered Knowledge, Attitudes, and Behaviors (KAB) survey, and a Physical Activity Questionnaire (PAQ). Barriers to physical activity at schools included a lack of facilities, equipment, and trained staff persons for PE. Adults were not consistently active with their children, but they were highly supportive of their children's activity level. Children reported a strong enjoyment of physical activity and strong peer support to be physically active. Weather conditions, safety concerns, and homework/chores were common barriers to physical activity reported by children and adult caregivers. The information was used to design culturally and age-appropriate, practical interventions including the five physical activity programs for schoolchildren in the Pathways study.

Whole grain intake and incident endometrial cancer: the Iowa Women's Health Study.

We examined whether there is an association between whole grain intake and incident endometrial cancer and whether the association varied by use of hormone replacement therapy. The study included 23,014 Iowa women, aged 55-69 years in 1986. A mailed food frequency questionnaire was used to estimate grain intake, hormone replacement therapy use, and other cancer risk factors. Cancer incidence from 1986 to 1998 was also collected. In analyses stratified by hormone replacement therapy use, an inverse association between whole grain intake and endometrial cancer was observed among never-users of hormone replacement therapy (p for trend = 0.05). Never-users in the highest quintile of whole grain intake were 0.63 times as likely to develop endometrial cancer as those in the lowest quintile of whole grain intake (95% confidence interval = 0.39-1.01). Among hormone replacement therapy users, no association between whole grain intake and endometrial cancer was evident. There was no statistically significant association between whole grain intake and incident endometrial cancer when users of hormone replacement therapy and nonusers were analyzed together. There also was no association between refined grain intake and endometrial cancer. Whole grain intake may protect against endometrial cancer among never-users of hormone replacement therapy.

Fast food restaurant use among women in the Pound of Prevention study: dietary, behavioral and demographic correlates.

OBJECTIVE: To examine demographic, behavioral and dietary correlates of frequency of fast food restaurant use in a community-based sample of 891 adult women. DESIGN: A survey was administered at baseline and 3 y later as part of a randomized, prospective intervention trial on weight gain prevention. SUBJECTS: Women (n = 891) aged 20-45 y who enrolled in the Pound of Prevention study. MEASUREMENTS: Frequency of fast food restaurant use, dietary intake, demographic and behavioral measures were self-reported. Dietary intake was measured using the 60-item Block Food Frequency Questionnaire. Body weight and height were directly measured. RESULTS: Twenty-one percent of the sample reported eating > or = 3 fast food meals per week. Frequency of fast food restaurant use was associated with higher total energy intake, higher percentage fat energy, more frequent consumption of hamburgers, French fries and soft drinks, and less frequent consumption of fiber and fruit. Frequency of fast food restaurant use was higher among younger women, those with lower income, non-White ethnicity, greater body weight, lower dietary restraint, fewer low-fat eating behaviors, and greater television viewing. Over 3 y, increases in frequency of fast food restaurant use were associated with increases in body weight, total energy intake, percentage fat intake, intake of hamburgers, French fries and soft drinks, and with decreases in physical activity, dietary restraint and low-fat eating behaviors. Intake of several other foods, including fruits and vegetables, did not differ by frequency of fast food restaurant use. CONCLUSION: Frequency of fast food restaurant use is associated with higher energy and fat intake and greater body weight, and could be an important risk factor for excess weight gain in the population.

Relationships between vitamin and mineral supplement use, dietary intake, and dietary adequacy among adolescents.

OBJECTIVE: To examine patterns of supplement use among US adolescents and the relationship between supplement use and dietary intake and adequacy. DESIGN: Adolescents self-reported 2 days of food intake using the 24-hour recall method and supplement use during a personal interview conducted as part of the 1994 Continuing Survey of Food Intakes of Individuals (CSFII). SUBJECTS: A national sample of 423 adolescents included in the 1994 CSFII survey. STATISTICAL ANALYSIS: chi 2 analysis was used to determine which demographic factors were significantly related to patterns of supplement use. Weighted percentages of adolescents by category of supplement use for selected vitamins and minerals (calcium; iron; zinc; folic acid; and vitamins A, B-6, C, and E) are presented. Relationships between dietary intake of macronutrients and vitamins and minerals among adolescents and supplement use were determined using a least-squares model of general linear regression. RESULTS: Approximately one-third of adolescents reported using supplements, with 15.6% of youth using them on a daily basis. The majority of supplement users reported taking multivitamins (N = 95; 65.5%) whereas only one-third of supplement users reported taking individual vitamins or minerals. Supplement use was found to vary by gender, household size, and US region of residence. Adolescents who reported using supplements had higher mean dietary intakes of most micronutrients and lower intakes of total and saturated fat than those who did not use supplements. More than one-third of adolescents had dietary intakes of vitamins A and E, calcium, and zinc that were < 75% of the US Recommended Dietary Allowance. APPLICATIONS/CONCLUSIONS: The majority of US adolescents do not use vitamin or mineral supplements. Interestingly, adolescents who do use supplements, even on an infrequent basis, consume diets that are more nutrient-dense than those who do not use supplements. Dietary intakes of several micronutrients were inadequate among all adolescents in this study, regardless of supplement use status. There is a need to develop and implement programs aimed at improving the dietary intakes of US adolescents.

Temporal trends in energy intake in the United States: an ecologic perspective.

BACKGROUND: The causes of recent increases in the prevalence of overweight in the United States are perplexing because national survey data do not show clear patterns of change in energy intake or expenditure. OBJECTIVE: Ecologic data regarding the quantities and types of foods and nutrients available in the United States between 1970 and 1998 were reviewed to provide an alternative perspective on trends in energy intake. DESIGN: Literature searches in agriculture, business, and medical library databases were conducted to identify data regarding the quantities and types of foods and nutrients available in the United States between 1970 and 1998. RESULTS: Per capita energy availability estimates from the US Department of Agriculture, US Food Supply Series, indicate that energy availability increased by 15% between 1970 and 1994. Data regarding trends in food purchasing and preparation suggest that Americans are eating more meals outside the home, relying more heavily on convenience foods, and consuming larger food portions. Americans appear, in some cases, to be selecting lower-fat foods over higher-fat alternatives. In addition, availability and sales of reduced-energy and reduced-fat products have increased. CONCLUSION: Consistent with trends in overweight, most of the ecologic data reviewed suggest that energy intake has increased over the past several decades and is likely a major contributor to increases in average body weight.

An interactive CD-ROM for nutrition screening and counseling.

OBJECTIVES: The goal of this project was to develop an interactive CD-ROM for nutrition screening and counseling, designed to produce dietary behavior change in fat and fruit and vegetable intake. METHODS: The design was based on principles of relevance to the learner, readiness for change, feedback, individualization, facilitation of skills, and goal setting. It was tested in community settings such as libraries, senior centers, and Women, Infants, and Children clinics. RESULTS: Nearly 80% of the respondents (n = 284), including numerous low-income persons, reported learning something new about nutrition and health or their own dietary habits. More than 50% of those recontacted 2 to 4 weeks later had put some of their dietary goals into practice. CONCLUSIONS: This program is useful for dietary screening, feedback, skill building, and motivation in settings in which in-person counseling by nutrition professionals is not feasible.

Weight-loss practices, nutrition beliefs, and weight-loss program preferences of urban American Indian women.

OBJECTIVE: To describe health beliefs, weight concern, dieting practices, and weight-loss program preferences of American Indian women residing in an urban setting. DESIGN: Face-to-face interviews using a semistructured questionnaire were conducted and height and weight were measured. SUBJECTS/SETTING: Subjects were 203 American Indian adult women in an urban community setting. STATISTICAL ANALYSIS: Frequency distributions and chi 2 analysis were performed using the Statistical Analysis System software. RESULTS: About two-thirds of the subjects were overweight. Most women were concerned about obesity and reported attempting to manage their weight. Healthful weight-loss practices (e.g., eating more fruits and vegetables, increasing physical activity) were used most frequently. However, unhealthful practices, such as skipping meals/fasting, using laxatives/diuretics, and self-induced vomiting were also mentioned. Regular bingeing was reported by 10% of respondents. APPLICATIONS: Weight-management intervention efforts should focus on helping clients modify their diet and physical activity patterns. Low-cost programs offered in convenient locations would attract more participants, as would the provision of child care. Education about the dangers and ineffectiveness of unhealthful weight-loss practices will be necessary, given the high rates of such behaviors in this population.

Diet and physical activity patterns of Lakota Indian adults.

OBJECTIVES: This study assessed specific dietary practices and overall physical activity patterns of Lakota adults residing on Indian reservations in South Dakota. Perceived barriers to changing dietary and physical activity behaviors were also examined. DESIGN: A convenience sample of Lakota adults was surveyed. Data on consumption of higher-fat foods, fruit and vegetable intake, use of sugar-sweetened beverages, physical activity patterns, and barriers to change in diet and physical activity were collected via in-person interviews. SUBJECTS/SETTING: A total of 219 adults from 2 adjacent reservations in South Dakota participated. RESULTS: Higher-fat foods consumed most frequently included margarine and butter (32.0% > or = 5 times per week); eggs (30.1% > or = 5 times per week); whole milk (25.7% > or = 5 times per week); potato chips, corn chips, and popcorn (15.1% > or = 5 times per week); and bacon and sausage (13.3% > or = 5 times per week). Few subjects reported consuming fruit on a daily basis. Vegetables were consumed somewhat more frequently. Most subjects reported engaging in mild or moderate physical activities 3 or more times per week, although women were found to engage in moderate and strenuous physical activities less frequently than men. Major barriers to fruit intake included expense (16.4%), quality (14.2%), and availability (13.2%). Barriers to vegetable intake mentioned most frequently included availability (11.4%), cost (10.4%), and quality (9.1%). Taste was the most frequently mentioned barrier to cutting intake of high-fat foods (27.9%). Lack of child care (15.8%), lack of time (14.7%), and safety concerns (14.6%) were the most salient barriers to regular exercise. APPLICATIONS/CONCLUSIONS: Nutrition interventions are needed that address the major barriers to diet change reported by Lakota adults. Efforts to increase physical activity should focus on Lakota women and should address the identified barriers to regular exercise.

Diet and physical activity patterns of urban American Indian women.

A cross sectional survey was conducted of American Indian women ages 18 years and older and residing in Minneapolis to assess dietary and physical activity practices. Results indicate a high amount of fat foods and low amount of fruits or vegetables consumed, and little regular physical activity. For adequate dietary intake, barriers included expense, and for physical activity barriers included lack of child care, health problems and safety concerns.

Soft drink consumption among US children and adolescents: nutritional consequences.

OBJECTIVE: To determine whether carbonated soft drink consumption is associated with consumption of milk, fruit juice, and the nutrients concentrated in these beverages. DESIGN: Data collected as part of the 1994 Continuing Survey of Food Intakes by Individuals were analyzed. Information on food and nutrient intake was derived from 2 days of dietary recall data collected via an in-person interview. SUBJECTS AND PARTICIPANTS: Nationally representative sample of people of all ages residing in the United States (response rate = 76.2%). Analyses were restricted to children aged 2 to 18 years (N = 1,810). STATISTICAL ANALYSES PERFORMED: Logistic regression analyses were conducted to predict the odds of low milk and juice consumption by soft drink consumption level. To determine whether intake of select nutrients varied by soft drink consumption, multiple linear regression modeling was conducted. Analyses were conducted using sample weights and software appropriate for the survey design. RESULTS: Energy intake was positively associated with consumption of nondiet soft drinks. For example, mean adjusted energy intake was 1,830 kcal/day for school-aged children who were nonconsumers of soft drinks compared with 2,018 kcal/day for children in this age group who consumed an average of 9 oz of soda or more per day. Those in the highest soft drink consumption category consumed less milk and fruit juice compared with those in the lowest consumption category (nonconsumers). CONCLUSIONS: Nutrition education messages targeted to children and/or their parents should encourage limited consumption of soft drinks. Policies that limit children's access to soft drinks at day care centers and schools should be promoted.

Guess who's cooking? The role of men in meal planning, shopping, and preparation in US families.

OBJECTIVES: To determine the role of men in meal-related tasks in households with both a male and female head, and to identify households in which the man is more likely to be involved in these tasks. DESIGN: Data collected as part of the US Department of Agriculture's 1994 Continuing Survey of Food Intakes of Individuals were analyzed. SUBJECTS/SETTING: All analyses were restricted to sampled persons who were identified as a male head of household residing in a household that also had a female head (N = 1,204). STATISTICAL ANALYSES: Frequency distributions were calculated and logistic regression analyses were conducted. RESULTS: Approximately 23%, 36%, and 27% of men reportedly were involved in meal planning, shopping, and preparation, respectively. Men in lower income and smaller households were more likely to be involved in each of the meal activities. Younger men and men in households in which the female head of household worked full-time were more likely to be involved in meal planning and preparation. IMPLICATIONS: Current education efforts to improve family nutrition tend to target the female rather than the male head of household. Our findings confirm that this focus is appropriate for most dual-headed households.

Association of cancer prevention-related nutrition knowledge, beliefs, and attitudes to cancer prevention dietary behavior.

OBJECTIVE: To examine the relationship of cancer prevention-related nutrition knowledge, beliefs, and attitudes to cancer prevention dietary behavior. SUBJECTS/SETTING: Noninstitutionalized US adults aged 18 years and older. METHODS: Data collected in the 1992 National Health Interview Survey Cancer Epidemiology Supplement were analyzed. The supplement included questions to ascertain knowledge, beliefs, and attitudes and a food frequency questionnaire to ascertain nutrient intake. STATISTICS: Multivariate linear regression modeling was conducted to assess the hypothesized relationships. RESULTS: After adjustment for relevant covariates (age, sex, education, total energy, perceived barriers to eating a more healthful diet), knowledge and belief constructs were predictive of dietary behavior. Specifically, fat, fiber, and fruit and vegetable intakes more closely approximated dietary recommendations for persons with more cancer-prevention knowledge. The strength of the associations between these constructs and dietary behavior varied in some cases according to level of education and perceived barriers to eating a healthful diet. Of the perceived barriers to eating a healthful diet, perceived ease of eating a healthful diet was most strongly and consistently predictive of intake. CONCLUSIONS: Research findings challenge dietetics practitioners to design diet- and health-promotion programs and activities that not only educate the public about the importance of diet to health, but also address barriers to dietary change.