Associations between level of interest in nutrition, knowledge of nutrition, and prevalence of orthorexia traits among undergraduate students.

Background: Orthorexia Nervosa (ON) is an unhealthy obsession wit "proper", "clean", or "healthful" eating that can potentially lead to serious physical, psychological, and social impairments. Aim: We aimed to examine associations between level of interest in nutrition, knowledge of nutrition, and prevalence of orthorexia traits in a population of college students enrolled in a general education nutrition course. Methods: Of the 579 students enrolled in the class during Spring semester of 2018, 221 (38%) completed an online survey. The survey was completed during weeks 8-9 of the 15-week semester. Results: The average nutrition knowledge score was 8.7 out of 12 (standard deviation (SD) 1.4, range 0-12). The average of the summed 29 orthorexia traits was 63.4 (SD 12.4; range = 41-102); lower scores indicated less agreeance with practicing ON behaviors. The degree of interest in the subject of nutrition was positively associated with prevalence of orthorexia traits (r = 0.43, p < 0.0001), but not nutrition knowledge (p > 0.05). Nutrition knowledge was inversely associated with prevalence of orthorexia traits (r = -0.19, p = 0.005). No associations were found between age, sex, year in school, or BMI and orthorexia traits. Conclusions: Interest in nutrition is associated with increased prevalence of orthorexia traits, however, higher levels of nutrition knowledge are associated with decreased prevalence of orthorexia traits. Additional studies should further examine these associations in prospective studies of nutrition/dietetics students as they progress in their programs and gain additional knowledge of nutrition.

A Randomized Controlled Trial Evaluating the FIT Game's Efficacy in Increasing Fruit and Vegetable Consumption.

Few children eat the recommended amounts of fruits and vegetables (FV). Although incentive-based interventions can increase FV consumption, this approach is costly and may be viewed as controversial due to the possible negative effects on intrinsic motivation. The FIT Game was designed to address these challenges. Four elementary schools were randomly assigned to either cooperatively play the FIT Game (n = 881) for ~8 weeks or to a no-game Control condition (n = 978). The FIT Game was presented daily as comic-book formatted episodes projected onto a large screen in the school cafeteria throughout lunchtime. All children could see the episodes which communicated daily whole-school vegetable-eating goals and illustrated the progress of the game's heroes when these goals were collectively met. Photo estimates of FV consumption and skin carotenoid concentrations (biomarker of carotenoid consumption) were collected at baseline, during the last 5 days of the FIT Game, and 3 months after the intervention concluded. Control schools followed the same FV consumption-monitoring procedures for the same duration. At the conclusion of the intervention phase, children attending the FIT Game schools consumed more vegetables (d = 0.41), more fruit (d = 0.39), and had higher skin carotenoids (d = 0.66) than at baseline. These statistically significant increases were maintained at a 3-month follow-up for vegetables (d = 0.21, the food targeted for change) and carotenoids (d = 0.53). Thus, the no-cost virtual incentives of the FIT Game increased FV consumption in the short- and long-run, without negatively impacting intrinsic motivation.

Nutritional Status is Associated With Severe Dementia and Mortality: The Cache County Dementia Progression Study.

PURPOSE: Studies have reported faster cognitive/functional decline in persons with dementia (PWD) with malnutrition. We investigated whether baseline nutritional status predicted severe dementia and mortality in a population-based sample. PATIENTS: A maximum of 300 PWD were assessed annually for up to 8.6 years. METHODS: Nutritional status was assessed using a modified Mini-Nutritional Assessment (mMNA). Severe dementia was defined as: "severe" rating on the Clinical Dementia Rating or Mini-Mental State Examination score ≤10. Using Cox proportional hazards models, we examined the association between baseline mMNA score (or its subcomponents) with each outcome. Covariates included demographics; dementia onset age, type, and duration; APOE genotype; and residency with caregiver. RESULTS: Compared with "well-nourished," "malnourished" PWD had 3-4 times the hazard of severe dementia [hazard ratio (HR), 4.31; P=0.014] and death (HR, 3.04; P<0.001). Those "at risk for malnutrition" had twice the hazard of severe dementia (HR, 1.98; P=0.064) and 1.5 times the hazard of death (HR, 1.46; P=0.015). mMNA subcomponents of food group intake, weight loss, body mass index, mobility, health status, protein consumption, and mid-arm circumference predicted one or both outcomes. CONCLUSIONS: Nutritional status is an important predictor of clinical outcomes in dementia and may provide an avenue for intervention.

Social approval bias in self-reported fruit and vegetable intake after presentation of a normative message in college students.

OBJECTIVE: To determine the accuracy of self-reported data regarding Fruit and Vegetable (FV) intake in college students at Utah State University after being presented with a descriptive normative message. INTERVENTION: Participants (N = 167) were recruited from general education courses and asked to complete a baseline survey containing a FV screener from the National Cancer Institute. They were then randomized to receive one of four messages one week after the initial survey and asked to immediately complete the same FV screener. The Control group received no FV message. The Recommendation group received a message that the recommendation for FV is 4-5 cups per day. The two normative groups received a message that either 80% of students ate more (Low) or less (High) FV than they did, regardless of actual intake, in addition to the recommended intake. ANALYSIS: Repeated measures ANOVA was used to assess differences in reported FV intake and perceived FV intake of peers between the first and second assessment. RESULTS AND CONCLUSIONS: Those receiving the message that they were in the lowest 20th percentile of intake reported a half-cup increase in self-reported FV intake and a one-cup increase in perception of peers' intake (p = 0.037 and p=<0.001, respectively). No significant differences were observed in other groups. These results indicate that normative messaging may influence self-reported FV intake and perception of peer intake of college students when this message indicates that the participant is in the lowest percentile of their peers.

The effect of social norms messaging regarding skin carotenoid concentrations among college students.

Descriptive social-normative messaging positively influences short-term dietary choices and healthy food intake. The purpose of this study was to evaluate the effects of descriptive normative messages on college students' skin carotenoid concentrations (a biomarker of carotenoid-containing fruit and vegetable [FV] intake) over an 8-week period. 251 college students consented to participate and 74% completed the study. Students were randomly assigned to groups who, following a baseline evaluation of skin-carotenoid levels, were told how their score ranked within a peer group of college students attending the same university (Individualized Normative group), that their score was in the lower 20th percentile of the peer group (Manipulated Normative group), or were given no information about their score or the peer group (Control group). Skin carotenoid concentrations were reassessed 8 weeks after the normative messages were presented or withheld. Skin carotenoid levels of those in the Manipulated Normative group increased significantly more than did scores of those in the Control group (t (126) = 3.74, p < 0.001; d = 0.67), but these students' self-reported FV intake did not increase. This finding suggests normative messaging can influence behavior for up to 8 weeks, but future research must better evaluate if the increase in skin carotenoids reflects increased FV consumption, increased consumption of carotenoid-containing FV (with decreased consumption of other FV), or is accounted for by some other behavior change (e.g., increased use of supplements). These findings support further exploration of normative messaging as a technique for producing the long-term behavior change needed to impact public health.

The FIT Game III: Reducing the Operating Expenses of a Game-Based Approach to Increasing Healthy Eating in Elementary Schools.

OBJECTIVE: Previously published versions of the healthy eating "FIT Game" were administered by teachers in all grades at elementary schools. The present study evaluated whether the game would retain its efficacy if teachers were relieved of this task; presenting instead all game materials on visual displays in the school cafeteria. MATERIALS AND METHODS: Participants were 572 children attending two Title 1 elementary schools (grades K-5). Following a no-intervention baseline period in which fruit and vegetable consumption were measured from food waste, the schools played the FIT Game. In the game, the children's vegetable consumption influenced events in a good versus evil narrative presented in comic book-formatted episodes in the school cafeteria. When daily vegetable-consumption goals were met, new FIT Game episodes were displayed. Game elements included a game narrative, competition, virtual currency, and limited player autonomy. The two intervention phases were separated by a second baseline phase (within-school reversal design). Simulation Modeling Analysis (a bootstrapping technique appropriate to within-group time-series designs) was used to evaluate whether vegetable consumption increased significantly above baseline levels in the FIT Game phases (P < 0.05). RESULTS: Vegetable consumption increased significantly from 21.3 g during the two baseline phases to 42.5 g during the FIT Game phases; a 99.9% increase. The Game did not significantly increase fruit consumption (which was not targeted for change), nor was there a decrease in fruit consumption. CONCLUSION: Labor-reductions in the FIT Game did not reduce its positive impact on healthy eating.

A Randomized Controlled Trial of the Food Dudes Program: Tangible Rewards are More Effective Than Social Rewards for Increasing Short- and Long-Term Fruit and Vegetable Consumption.

BACKGROUND: Despite many health benefits, children do not consume enough fruits and vegetables (F/V). The Food Dudes program increases in-school F/V consumption, but the cost of prizes might be an adoption barrier. OBJECTIVE: Our aim was to compare the effects of the Food Dudes program when prizes vs praise are used to reward F/V consumption. DESIGN: We conducted a randomized controlled trial with three groups (ie, prize, praise, and control). Schools were randomly assigned to groups while approximately equating the percentage of students qualifying for free or reduced-price lunch. F/V consumption (lunch-tray photos) was assessed twice at pre-intervention and once after phase I, phase II, and at 6 months post-intervention, spanning approximately 11 months overall. PARTICIPANTS/SETTING: In total, 2,292 students attending six elementary schools participated, with 882, 640, and 770 in the prize, praise, and control groups, respectively. INTERVENTION: The Food Dudes program was implemented over 4.5 months in all but the control schools. Two Food Dudes schools implemented the program with tangible prizes contingent on individual students' F/V consumption (prize group); two schools implemented Food Dudes using teacher praise instead of prizes (praise group). Follow-up data were collected 6 months post-intervention. MAIN OUTCOME MEASURE: F/V consumption was assessed by digital imaging of lunch trays. STATISTICAL ANALYSIS PERFORMED: Linear mixed-effects modeling, including sex, grade, and baseline consumption as covariates, was performed. RESULTS: Students attending the Food Dudes schools consumed more F/V than control schools after phase I, with larger differences in prize schools (92% difference) than praise schools (50% difference). After phase II, Food Dudes schools consumed 46% more F/V than control schools, with no difference between prize and praise schools. At 6-month follow-up, only prize schools consumed more F/V than control schools (0.12 cups more per child, 42.9% difference). CONCLUSIONS: Social praise proved an inadequate substitute for tangible prizes within the Food Dudes program. Program-related increases in F/V consumption decreased after the intervention, underscoring the need to develop low-cost, long-term interventions to maintain and make habitual consumption of recommended levels of F/V.

Skin Carotenoid Response to a High-Carotenoid Juice in Children: A Randomized Clinical Trial.

BACKGROUND: Previous studies have shown an increase in serum carotenoid status among children when fed carotenoids. This study looked at the effect and dose-response of a known amount of carotenoid consumption on change in skin carotenoid status among children. METHODS: Participants were children aged 5 to 17 years from Cache County, UT (n=58). Children were randomly assigned to one of three groups: high (n=18) or low (n=18) dose of a carotenoid-rich juice (2.75 mg carotenoids/30 mL juice), or placebo juice (n=22). Children were asked to drink an assigned dose of the juice (30 to 120 mL/day) based on the weight of the child and group assignment, every day for 8 weeks. Skin carotenoids were measured every 2 weeks by resonance Raman spectroscopy. Participants were asked to maintain their usual diet throughout the study. Usual diet was assessed using three averaged 24-hour recalls; diet constancy was measured using food frequency questionnaires administered at baseline, Week 4, and Week 8. Repeated measures analysis of variance was used to assess the group differences in skin carotenoid status over time. RESULTS: The high-dose and low-dose groups had mean±standard deviation increases in skin carotenoid status of 11,515±1,134 and 10,009±1,439 Raman intensity counts, respectively (both P values <0.001, for change in means compared with baseline) at Week 8, although they showed significant change from baseline by Week 2. The placebo group's change of 985 Raman intensity counts was not statistically significant. The difference in change between the 2 experimental groups was not significant at Week 2, 4, 6, or 8. CONCLUSIONS: Consumption of 30 to 120 mL (2.75 to 11 mg carotenoids) of a carotenoid-rich juice significantly increased skin carotenoid status over an 8-week period among children aged 5 to 17 years. The amount of carotenoids found in this amount of juice is equal to the amount found in approximately 23 to 92 g cooked carrots per day.

Knowledge of the female athlete triad, and prevalence of triad risk factors among female high school athletes and their coaches.

STUDY OBJECTIVE: This study aimed to determine awareness/knowledge of the Triad and its health implications among female high school athletes and their coaches, and to evaluate coaches' Triad screening/intervention practices. DESIGN: Cross-sectional survey. SETTING: Two high schools in the western United States. PARTICIPANTS: Female athletes from a variety of sports (N = 240) ages 14-18 years and their coaches (N = 10). INTERVENTION: Participants completed surveys that assessed Triad knowledge and athlete Triad risk factors. MAIN OUTCOME MEASURES: Frequency of responses to Triad knowledge, Triad risk factor, and Triad education/screening procedures questions; athlete summative knowledge score. RESULTS: Half (N = 120) of participants reported menstrual irregularity, and 42% (N = 101) had 2 or more Triad risk factors: past amenorrhea (N = 39), past stress fracture (N = 41), self-reported not eating enough (N = 53), underweight (BMI-for-age < 5(th) percentile) (N = 10), pressure to be a certain weight (N = 143), and wanting to lose >10 pounds when self-reported weight was in a healthy range (N = 34). Average athlete Triad knowledge score was 2.97 ± 1.61 out of 8. Coach Triad knowledge was limited; however, most (9/10) were comfortable discussing menstruation with their athletes. Barriers to Triad screening/education were coaches' insufficient time, knowledge, and educational resources. CONCLUSION: Triad risk factors were prevalent among athletes and coach and athlete Triad knowledge was low. Providing coaches with Triad screening/education training may increase Triad knowledge and decrease Triad risk among high school athletes.

Skin carotenoids: a biomarker of fruit and vegetable intake in children.

BACKGROUND: Studies of adult subjects have found a strong correlation between serum carotenoids and skin carotenoids measured by resonance Raman spectroscopy (RRS). No published studies have examined correlations between skin and serum carotenoids among children. OBJECTIVES: We aimed to validate skin RRS methodology against serum carotenoid measurements by high-performance liquid chromatography and to determine whether RRS can be used as a valid biomarker of fruit and vegetable (F/V) intake among children. DESIGN: In our cross-sectional study, participants were 45 healthy children aged 5 to 17 years who provided three blood samples used to assess serum carotenoid concentrations and three RRS skin measurements of the palm within a 4-week period. Dietary intake of F/V was assessed three times within 4 weeks using a 27-item food frequency questionnaire (FFQ) and an automated multiple-pass 24-hour daily recall. Estimates of intake from three FFQs, completed at least 7 days apart, were averaged. Estimates of intake from 24-hour daily recalls were collected on 2 weekdays and 1 weekend day and averaged. RESULTS: Levels of skin and serum carotenoids were highly correlated (R(2)=0.62; P<0.001). A linear regression model, controlling for child's weight and scanner unit, predicted that for every unit increase of total F/V from FFQ and total F/V as assessed by 24-hour daily recall, RRS intensity was predicted to increase by 3,798 (P=0.001) and 3,504 (P=0.001), respectively. Similar results were observed for reported high-carotenoid vegetable intake. Total carotenoid and beta carotene levels from 24-hour daily recalls correlated to total serum carotenoids levels (P<0.01 and P<0.05, respectively). Total carotenoid, alpha carotene, and beta carotene levels from the 24-hour daily recalls correlated to RRS (P<0.01). CONCLUSIONS: Skin carotenoids measured by RRS were strongly correlated with serum carotenoid levels and were positively associated with estimates of intake from FFQ and an automated multiple-pass 24-hour daily recall among children aged 5 to 17 years. Skin carotenoids may be used as valid biomarker of F/V intake among children.

The FIT Game: preliminary evaluation of a gamification approach to increasing fruit and vegetable consumption in school.

OBJECTIVE: Incentive-based interventions designed to increase fruit and vegetable (FV) consumption tend to yield positive, short-term outcomes. Because consumption most often returns to baseline levels when incentives are removed, sustainable long-duration interventions may be needed to impact public health. Anticipating that low-cost interventions will be more appealing to schools, the present study explored a low-cost, game-based intervention. METHOD: An alternating-treatments design was used to evaluate the effects of the FIT Game on objectively measured FV consumption in one elementary school (n=251) in Utah. During the Fall 2013 semester, game-based rewards were provided to heroic characters within a fictional narrative read by teachers on days when the school, as a whole, met a fruit or vegetable consumption goal in accord with the alternating-treatments design. RESULTS: On intervention days, fruit and vegetable consumption increased by 39% and 33%, (p<0.01, p<0.05; binomial tests), respectively. Teacher surveys indicated that students enjoyed the game and grade 1-3 teachers recommended its use in other schools. CONCLUSION: This game-based intervention provides a promising step towards developing a low-cost, effective, and sustainable FV intervention that schools can implement without outside assistance.

Gamification of dietary decision-making in an elementary-school cafeteria.

Despite the known health benefits of doing so, most US children do not consume enough fruits and vegetables (FV). School-based interventions can be effective in increasing FV consumption, but the most effective of these require that schools allocate their time, effort, and financial resources to implementing the program: expenditures that schools may be reluctant to provide in climates of academic accountability and economic austerity. The present demonstration project used a behaviorally based gamification approach to develop an intervention designed to increase FV consumption while minimizing material and labor costs to the school. During the intervention, the school (N = 180 students in grades K-8) played a cooperative game in which school-level goals were met by consuming higher-than-normal amounts of either fruit or vegetables (alternating-treatments experimental design). School-level consumption was quantified using a weight-based waste measure in the cafeteria. Over a period of 13 school days, fruit consumption increased by 66% and vegetable consumption by 44% above baseline levels. Use of an alternating-treatment time-series design with differential levels of FV consumption on days when fruit or vegetable was targeted for improvement supported the role of the intervention in these overall consumption increases. In post-intervention surveys, teachers rated the intervention as practical in the classroom and enjoyed by their students. Parent surveys revealed that children were more willing to try new FV at home and increased their consumption of FV following the intervention. These findings suggest that a behaviorally based gamification approach may prove practically useful in addressing concerns about poor dietary decision-making by children in schools.

Incentivizing children's fruit and vegetable consumption: results of a United States pilot study of the Food Dudes Program.

OBJECTIVE: Preliminary evaluation in the United States (US) of a school-based fruit and vegetable (F/V) intervention, known as the Food Dudes (FD) program, developed in the United Kingdom. METHODS: Over 16 days (Phase 1), elementary-school children (n = 253) watched short videos featuring heroic peers (the FD) eating F/V and received a reward for eating F/V served at lunchtime. In the 3 months that followed (Phase 2), children received increasingly intermittent rewards for eating F/V. Consumption was measured by photo analysis and assessment of skin carotenoids. RESULTS: Fruit and vegetable intake increased significantly after Phases 1 and 2 (P < .001 for both). This effect was most discriminable among children who consumed no fruit (n = 100) or no vegetables (n = 119) at pre-intervention baseline. Among these children, F/V intake (combined) increased by 0.49 (0.53) cups per day. CONCLUSIONS AND IMPLICATIONS: The FD program can increase F/V intake in US elementary schools.

Increased self-efficacy for vegetable preparation following an online, skill-based intervention and in-class tasting experience as a part of a general education college nutrition course.

PURPOSE: Assess the effectiveness of the integration of vegetable demonstration videos and tasting experiences into a college nutrition course to influence students' readiness to change vegetable intake, self-efficacy for vegetable preparation, and usual vegetable intake. DESIGN: Quasiexperimental, preintervention-postintervention comparisons. SETTING: College nutrition course. SUBJECTS: Of the 376 students enrolled in the course, 186 completed the online assessments (145 female, 41 male; mean age, 20 years). INTERVENTION: Participants viewed online vegetable preparation videos and participated in vegetable tasting experiences that featured four target vegetables, one vegetable each month for 4 months. MEASURES: Preintervention and postintervention online surveys determined usual vegetable intake, readiness to change vegetable consumption, and self-efficacy of vegetable preparation. ANALYSIS: Chi-square distribution and paired sample t-tests were used to examine differences preintervention and postintervention. RESULTS: Stage of readiness to change vegetable intake shifted from contemplation toward preparation (p < .001). Self-efficacy of vegetable preparation increased and postintervention self-efficacy was associated with total and target vegetable consumption (p  =  .001 and p  =  .005, respectively). The average intake of asparagus, one of four target vegetables, increased (p  =  .016); similar changes were not observed for target or total vegetable consumption. CONCLUSION: Online vegetable demonstration videos may be an effective and cost-efficient intervention for increasing self-efficacy of vegetable preparation and readiness to increase vegetable consumption among college students. More research is needed to determine long-term effects on vegetable consumption.

Correlation of age-specific phenylalanine levels with intellectual outcome in patients with phenylketonuria.

Patients with treated phenylketonuria (PKU) can have subtle deficits in intellect, academic skills, and executive functioning. This study evaluates the relationship between intellectual outcome and concentration/variation in blood phenylalanine (Phe) during specific developmental periods (0-6 years, 7-12 years, >12 years) in our patients with PKU. Verbal comprehension, perceptual reasoning, and processing speed were used as measures of intelligence. Data were collected from 55 patients receiving treatment at the University of Utah Metabolic Clinic. Yearly median Phe levels increased and mean number of blood Phe samples decreased as patients aged. Yearly median blood Phe from 0-6 and 7-12 years were inversely associated with perceptual reasoning abilities using linear regression. Additionally, increased blood Phe concentration negatively impacted specific areas of verbal comprehension abilities for those 0-6 years of age (p = 0.001). Variation of Phe levels around the mean (assessed as standard deviation) in each patient was associated with diagnostic (highest pretreatment) Phe levels and yearly median Phe levels (p < 0.001 for both), but did not significantly impact intelligence in our group of patients. Frequent blood Phe monitoring from 7-12 years significantly reduced the probability of yearly median Phe exceeding 360 µM (p = 0.005). Our data show that compliance with treatment in patients with PKU affects both the concentration and variation of blood Phe levels, and may have a greater impact on verbal comprehension and perceptual reasoning skills during the first 12 years of life when compared the influence beyond 12 years.

Diet quality is associated with better cognitive test performance among aging men and women.

Most studies of association between diet and cognition among the elderly focus on the role of single nutrients or foods and ignore the complexity of dietary patterns and total diet quality. We prospectively examined associations between an index of diet quality and cognitive function and decline among elderly men and women of the Cache County Study on Memory and Aging in Utah. In 1995, 3634 resident men and women > or =65 y of age completed a baseline survey that included a 142-item FFQ. Cognition was assessed using an adapted version of the Modified Mini-Mental State Examination (3MS) at baseline and 3 subsequent interviews spanning approximately 11 y. A recommended food score (RFS) and non-RFS were computed by summing the number of recommended foods (n = 57) and nonrecommended foods (n = 23) regularly consumed. Multivariable-mixed models were used to estimate associations between the RFS and non-RFS and average 3MS score over time. Those in the highest quartile of RFS scored 1.80 points higher on the baseline 3MS test than did those in the lowest quartile of RFS (P < 0.001). This effect was strengthened over 11 y of follow-up. Those with the highest RFS declined by 3.41 points over 11 y compared with the 5.2-point decline experienced by those with the lowest RFS (P = 0.0013). The non-RFS was not associated with cognitive scores. Consuming a diverse diet that includes a variety of recommended foods may help to attenuate age-related cognitive decline among the elderly.

Change in diet, physical activity, and body weight among young-adults during the transition from high school to college.

BACKGROUND: The freshmen year of college is likely a critical period for risk of weight gain among young-adults. METHODS: A longitudinal observational study was conducted to examine changes in weight, dietary intake, and other health-related behaviors among first-year college students (n = 186) attending a public University in the western United States. Weight was measured at the beginning and end of fall semester (August - December 2005). Participants completed surveys about dietary intake, physical activity and other health-related behaviors during the last six months of high school (January - June 2005) in August 2005 and during their first semester of college (August - December 2005) in December 2005. RESULTS: 159 students (n = 102 women, 57 men) completed both assessments. The average BMI at the baseline assessment was 23.0 (standard deviation (SD) 3.8). Although the average amount of weight gained during the 15-week study was modest (1.5 kg), 23% of participants gained > or = 5% of their baseline body weight. Average weight gain among those who gained > or = 5% of baseline body weight was 4.5 kg. Those who gained > or = 5% of body weight reported less physical activity during college than high school, were more likely to eat breakfast, and slept more than were those who did not gain > or = 5% of body weight. CONCLUSION: Almost one quarter of students gained a significant amount of weight during their first semester of college. This research provides further support for the implementation of education or other strategies aimed at helping young-adults entering college to achieve or maintain a healthy body weight.

Risk of mortality with vitamin E supplements: the Cache County study.

PURPOSE: A recent meta-analysis reported increased mortality in clinical trial participants randomized to high-dose vitamin E. We sought to determine whether these mortality risks with vitamin E reflect adverse consequences of its use in the presence of cardiovascular disease. METHODS: In a defined population aged 65 years or older, baseline interviews captured self- or proxy-reported history of cardiovascular illness. A medicine cabinet inventory verified nutritional supplement and medication use. Three sources identified subsequent deaths. Cox proportional hazards methods examined the association between vitamin E use and mortality. RESULTS: After adjustment for age and sex, there was no association in this population between vitamin E use and mortality (adjusted hazard ratio [aHR] 0.93; 95% confidence interval [CI], 0.74-1.15). Predictably, deaths were more frequent with a history of diabetes, stroke, coronary artery bypass graft surgery, or myocardial infarction, and with the use of warfarin, nitrates, or diuretics. None of these conditions or treatments altered the null main effect with vitamin E, but mortality was increased in vitamin E users who had a history of stroke (aHR 3.64; CI, 1.73-7.68), coronary bypass graft surgery (aHR 4.40; CI, 2.83-6.83), or myocardial infarction (aHR 1.95; CI, 1.29-2.95) and, independently, in those taking nitrates (aHR 3.95; CI, 2.04-7.65), warfarin (aHR 3.71; CI, 2.22-6.21), or diuretics (aHR 1.83; CI, 1.35-2.49). Although not definitive, a consistent trend toward reduced mortality was seen in vitamin E users without these conditions or treatments. CONCLUSIONS: In this population-based study, vitamin E use was unrelated to mortality, but this apparently null finding seems to represent a combination of increased mortality in those with severe cardiovascular disease and a possible protective effect in those without.

Antioxidant intake and risk of osteoporotic hip fracture in Utah: an effect modified by smoking status.

The role of antioxidant intake in osteoporotic hip fracture risk is uncertain and may be modified by smoking. In the Utah Study of Nutrition and Bone Health, a statewide, population-based case-control study, the authors investigated whether antioxidant intake was associated with risk of osteoporotic hip fracture and whether this association was modified by smoking status. The analyses included data on 1,215 male and female cases aged > or = 50 years who incurred a hip fracture during 1997-2001 and 1,349 age- and sex-matched controls. Diet was assessed by food frequency questionnaire. Among ever smokers, participants in the highest quintile of vitamin E intake (vs. the lowest) had a lower risk of hip fracture after adjustment for confounders (odds ratio = 0.29, 95% confidence interval (CI): 0.16, 0.52; p-trend < 0.0001). The corresponding odds ratio for beta-carotene intake was 0.39 (95% CI: 0.23, 0.68; p-trend = 0.0004), and for selenium intake it was 0.27 (95% CI: 0.12, 0.58; p-trend = 0.0003). Vitamin C intake did not have a significant graded association with hip fracture risk among ever smokers. Similar findings were obtained when an overall antioxidant intake score was used (odds ratio = 0.19, 95% CI: 0.10, 0.37; p-trend < 0.0001). No similar associations were found in never smokers. Antioxidant intake was associated with reduced risk of osteoporotic hip fracture in these elderly subjects, and the effect was strongly modified by smoking status.

Dietary protein intake and risk of osteoporotic hip fracture in elderly residents of Utah.

UNLABELLED: The role of protein intake in osteoporosis is unclear. In a case-control study in Utah (n = 2501), increasing level of protein intake was associated with a decreased risk of hip fracture in men and women 50-69 years of age but not in those 70-89 years of age. Protein intake may be important for optimal bone health. INTRODUCTION: Protein is an important component of bone, but the role of dietary protein intake in osteoporosis and fracture risk remains controversial. MATERIAL AND METHODS: The role of dietary protein intake in osteoporotic hip fracture was evaluated in a statewide case-control study in Utah. Patients, 50-89 years of age, with hip fracture (cases) were ascertained through surveillance of 18 Utah hospitals during 1997-2001. Age- and gender-matched controls were randomly selected. Participants were interviewed in their place of residence, and diet was assessed using a picture-sort food frequency questionnaire previously reported to give a useful measure of usual dietary intake in the elderly Utah population. The association between protein intake and risk of hip fracture was examined across quartiles of protein intake and stratified by age group for 1167 cases (831 women, 336 men) and 1334 controls (885 women, 449 men). RESULTS: In logistic regression analyses that controlled for gender, body mass index, smoking status, alcohol use, calcium, vitamin D, potassium, physical activity, and estrogen use in women, the odds ratios (OR) of hip fracture decreased across increasing quartiles of total protein intake for participants 50-69 years of age (OR: 1.0 [reference]; 0.51 [95% CI: 0.30-0.87]; 0.53 [0.31-0.89]; 0.35 [0.21-0.59]; p < 0.001). No similar associations were observed among participants 70-89 years of age. Results from analyses stratified by low and high calcium and potassium intake did not differ appreciably from the results presented above. CONCLUSION: Higher total protein intake was associated with a reduced risk of hip fracture in men and women 50-69 years of age but not in men and women 70-89 years of age. The association between dietary protein intake and risk of hip fracture may be modified by age. Our study supports the hypothesis that adequate dietary protein is important for optimal bone health in the elderly 50-69 years of age.