Normative data for the Brief Symptom Inventory for patients with Crohn's disease.

OBJECTIVE: The Brief Symptom Inventory (BSI) is a self-report measure of psychological symptoms in clinical and non-clinical populations. However, norms for BSI are lacking for patients with chronic illness, such as Crohn's disease (CD). This study aimed to provide BSI clinical norms using a cohort of CD patients. DESIGN: Adult Israeli CD patients (n = 430) completed questionnaires regarding clinical, demographic and psychological aspects of disease, including BSI. Their BSI data were compared with published norms from adult Israeli population and British psychiatric outpatients. RESULTS: CD patients in active disease state had higher levels of mental health symptoms than those in remission. Interestingly, levels of symptomatology did not differ with respect to disease duration. No significant sex differences in BSI dimensions were found, with the exception of somatization. Being younger than 60 years and having lower economic status were associated with more severe psychological symptoms. Psychological symptom levels in CD patients were high in comparison to the Israeli general population, but low compared to British psychiatric outpatients. CONCLUSION: Results confirm the link between CD and elevated psychological symptoms. The findings highlight the need to use appropriate BSI norms when assessing clinically significant levels of psychological symptoms in non-psychiatric patients with chronic illness.

Health-care costs of inflammatory bowel disease in a pan-European, community-based, inception cohort during 5 years of follow-up: a population-based study.

BACKGROUND: Inflammatory bowel disease (IBD) places a significant burden on health-care systems because of its chronicity and need for expensive therapies and surgery. With increasing use of biological therapies, contemporary data on IBD health-care costs are important for those responsible for allocating resources in Europe. To our knowledge, no prospective long-term analysis of the health-care costs of patients with IBD in the era of biologicals has been done in Europe. We aimed to investigate cost profiles of a pan-European, community-based inception cohort during 5 years of follow-up. METHODS: The Epi-IBD cohort is a community-based, prospective inception cohort of unselected patients with IBD diagnosed in 2010 at centres in 20 European countries plus Israel. Incident patients who were diagnosed with IBD according to the Copenhagen Diagnostic Criteria between Jan 1, and Dec 31, 2010, and were aged 15 years or older the time of diagnosis were prospectively included. Data on clinical characteristics and direct costs (investigations and outpatient visits, blood tests, treatments, hospitalisations, and surgeries) were collected prospectively using electronic case-report forms. Patient-level costs incorporated procedures leading to the initial diagnosis of IBD and costs of IBD management during the 5-year follow-up period. Costs incurred by comorbidities and unrelated to IBD were excluded. We grouped direct costs into the following five categories: investigations (including outpatient visits and blood tests), conventional medical treatment, biological therapy, hospitalisation, and surgery. FINDINGS: The study population consisted of 1289 patients with IBD, with 1073 (83%) patients from western Europe and 216 (17%) from eastern Europe. 488 (38%) patients had Crohn's disease, 717 (56%) had ulcerative colitis, and 84 (6%) had IBD unclassified. The mean cost per patient-year during follow-up for patients with IBD was €2609 (SD 7389; median €446 [IQR 164-1849]). The mean cost per patient-year during follow-up was €3542 (8058; median €717 [214-3512]) for patients with Crohn's disease, €2088 (7058; median €408 [133-1161]) for patients with ulcerative colitis, and €1609 (5010; median €415 [92-1228]) for patients with IBD unclassified (p<0·0001). Costs were highest in the first year and then decreased significantly during follow-up. Hospitalisations and diagnostic procedures accounted for more than 50% of costs during the first year. However, in subsequent years there was a steady increase in expenditure on biologicals, which accounted for 73% of costs in Crohn's disease and 48% in ulcerative colitis, in year 5. The mean annual cost per patient-year for biologicals was €866 (SD 3056). The mean yearly costs of biological therapy were higher in patients with Crohn's disease (€1782 [SD 4370]) than in patients with ulcerative colitis (€286 [1427]) or IBD unclassified (€521 [2807]; p<0·0001). INTERPRETATION: Overall direct expenditure on health care decreased over a 5-year follow-up period. This period was characterised by increasing expenditure on biologicals and decreasing expenditure on conventional medical treatments, hospitalisations, and surgeries. In light of the expenditures associated with biological therapy, cost-effective treatment strategies are needed to reduce the economic burden of inflammatory bowel disease. FUNDING: Kirsten og Freddy Johansens Fond and Nordsjællands Hospital Forskningsråd.

Effect of Social Support on Psychological Distress and Disease Activity in Inflammatory Bowel Disease Patients.

Background: Psychological distress increases morbidity in ulcerative colitis (UC) and Crohn's disease (CD). We examined whether social support is associated with distress and disease activity. Methods: There were 110 UC and 147 CD patients who completed sociodemography, economic status, disease activity (UC: Patient Simple Clinical Colitis Activity Index (P-SCCAI), CD: Patient Harvey-Bradshaw Index . (P-HBI), Multidimensional Scale of Perceived Social Support (MSPSS), Brief Symptom Inventory with Global Severity Index (GSI) of psychological distress, and 2 health-related quality-of-life scales (SF-36 Physical Health and Mental Health, and Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Analysis included multiple linear regressions and structural equation modeling. Results: Disease activity was mild: UC: P-SCCAI 2.9 ± 3.5, CD: P-HBI 4.7 ± 4.7. Physical Health was better in UC 46.6 ± 11.4 versus CD 43.7 ± 10.9 (P < .02). GSI was lower in UC 0.6 ± 0.7 than CD 0.8 ± 0.7 (P = .002). MSPSS total score was equal in UC (5.9 ± 1.2) and CD (5.9 ± 1.1). MSPSS total correlated with P-SCCAI (correlation coefficient ‒0.240), GSI in UC (‒0.470), and GSI in CD (‒0.333). Economic status correlated with GSI in UC (‒0.408) and CD (‒0.356). MSPSS predicted GSI, Mental Health, and SIBDQ in UC and CD, and predicted P-SCCAI but not P-HBI; economic status predicted all the foregoing. Path analysis depicted GSI as mediating the effects of MSPSS and economic status on disease activity in both UC and CD. MSPSS (UC: ß â€’0.34, CD: ß â€’0.37) and economic status (UC: ß â€’0.38, CD: ß â€’0.22) reduced GSI, which then increased the disease activity (UC: ß 0.56, CD: ß 0.42). Conclusions: Social support and economic status are linked to UC and CD patients' well-being. Interventions addressing these issues should be part of management.

Differing Relationship of Psycho-Social Variables with Active Ulcerative Colitis or Crohn's Disease.

PURPOSE: How psycho-social variables affect the degree of disease activity in patients with ulcerative colitis (UC) or Crohn's disease (CD) is incompletely understood. Therefore, we measured and compared the impact of psycho-social variables on the active disease state in UC and CD. METHOD: One hundred and twenty-two UC and 305 CD patients with active disease completed questionnaires detailing their psychological symptoms, threatening experiences, disease-coping strategies, satisfaction with life, quality of life, and demographics. RESULTS: UC and CD patients were aged (mean, SD) 38.6 ± 14.0 and 45.2 ± 15.1 years, respectively. The psychological symptom index (median, IQR) was greater in UC 1.24 (0.8) than CD 0.9 (0.8), p < 0.001. UC used more emotion-focused strategies, 24.5 (5.7) than CD, 23.0 (5.7), p < 0.03; problem-focused strategies, 16.4 (4.5) vs. 15.4 (4.2), p < 0.04; and dysfunctional strategies, 23.7 (5.7) vs. 22.0 (5.0), p < 0.01. UC activity correlated with gender, age, economic status, psychological symptoms, threatening experiences, all coping strategies, satisfaction with life, and quality of life (p < 0.02-0.001). CD activity correlated with economic status, psychological symptoms, threatening experiences, dysfunctional strategies, satisfaction with life, and quality of life (p < 0.05-0.001). UC activity was predicted by psychological symptoms (9.1% variance), economic status (6.9%), problem-focused strategies (4.2%), and threatening experiences (1.3%); CD activity by threatening experiences (5% variance) and psychological symptoms (4%). In path analysis, psychological symptoms and problem-focused strategies mediated the effects of economic status, age, and threatening experiences on UC activity. In CD, the dominant pathway was threatening experiences impacting on psychological symptoms. CONCLUSION: The impact of psycho-social variables on the active disease state differs between UC and CD, thus indicating a need for specifically tailored psychotherapies.

Daily hassles score associates with the somatic and psychological health of patients with Crohn's disease.

OBJECTIVE: To examine the associations of daily hassles with the somatic and psychological health of Crohn's disease (CD) patients. METHOD: A cross-sectional study of 400 self-selected adult CD patients was performed with completion of demographic, medical, and psychosocial questionnaires: economic status; Patient Harvey-Bradshaw Index of disease activity; Daily Hassles Scale (DHS); Short Inflammatory Bowel Disease Questionnaire (SIBDQ) and Short-Form Health Survey (SF-36 Physical and Mental Health) quality of life measures; Brief Symptom Inventory of psychological stress with summary Global Severity Index (GSI); Family Assessment Device; and List of Threatening Life Experiences. Analyses included correlations, regressions, and Sobel test statistic. RESULTS: The patients were aged 38.7 ± 14.1 years, 61% female and 67% working. The Patient Harvey-Bradshaw Index was 5.52 ± 4.87. The DHS was 88.0 ± 23.2, similar in men and women, higher in smokers, and increased with greater disease activity (p < .001). The most commonly reported hassles were time, social, and work. DHS had significant negative correlations with age, disease duration, and economic status and positive correlations with GSI, SF-36, and SIBDQ. An increased Daily Hassles score was associated with reduced SIBDQ (p < .001) and SF-36 Mental Health (p < .001) and increased GSI (p < .001) and Patient Harvey-Bradshaw Index (p < .001). This effect of DHS on Patient Harvey-Bradshaw Index was mediated by GSI (Sobel t = 6.09, p < 0.001). CONCLUSION: Daily hassles in CD patients are shown for the first time to be associated with increased psychological stress and disease activity and reduced quality of life and lower economic status. This has psychotherapeutic implications.

[TRAINING WORKSHOPS FOR BEDOUIN MOTHERS: PREVENTION OF IRON DEFICIENCY ANEMIA IN CHILDREN - RESULTS FROM A COMMUNITY TRIAL STUDY].

INTRODUCTION: Anemia is the most common nutritional deficiency in the world, contributing to childhood morbidity and mortality. Knowledge, attitudes and behavior of caretakers and parents of toddlers can significantly prevent anemia. OBJECTIVES: Assessment of workshop intervention to alter knowledge, attitudes and behavior in mothers of toddlers in the Bedouin population. METHODS: Community trial study. The intervention group included: 150 mothers of healthy one-year-old toddlers receiving workshops culturally tailored for a month in addition to standard training in "Tipat-Halav" (Baby clinic). The control group included: 101 mothers of healthy one-year-old toddlers who received standard training. At the endpoint, mothers were tested in both groups to determine levels of knowledge based on the knowledge and attitudes questionnaire, and the food intake of their children was reviewed according to the Food Frequency Questionnaire (FFQ). RESULTS: Intervention group mothers correctly answered significantly more questions on knowledge and attitudes than the control group; 87.3% of the intervention group recognized the importance of giving iron supplements to prevent anemia compared to 73.3% in the control group (p=0.004). Over three-quarters of the intervention group and half of the control group knew that food affects mental development (p=0.001). In logistic regression, neutralization of SES variables, the intervention increased the rate mothers correctly answered questions 2 to 2.6 fold compared with the control group (p˂0.05). According to the FFQ, children in the intervention group ate more iron-rich foods of animal and vegetarian origin compared to the control group (p<0.05). CONCLUSIONS: The intervention improved the knowledge and behavior of mothers in preventing anemia in toddlers. It should be required to provide information and training activities for mothers of toddlers beyond standard training, increasing the awareness of foods rich in iron. This activity can be performed using cultural workshops on iron deficiency, as was performed in this study.

[IS THERE A WAY TO REDUCE IRON DEFICIENCY ANEMIA RATES IN THE SECOND YEAR OF LIFE OF BEDOUIN CHILDREN IN THE NEGEV?]

INTRODUCTION: Iron deficiency anemia is the most common worldwide nutritional deficiency contributing to childhood morbidity and mortality. According to the official health policy in Israel, providing iron for all babies from the age of 4 months to the age of one year old is recommended. This policy also recommends providing iron supplementation for an additional 6 months for toddlers (who are one year old) with anemia (hemoglobin<11mg/dl). Despite this policy, there is still a high rate of anemia in the Negev's two year old children, especially in the Bedouin population. OBJECTIVES: Assessment of the intervention program to reduce iron deficiency anemia rates, that provides iron supplementation to Bedouin toddlers with no anemia, from the age of 1 year to 18 months and maternal knowledge about the prevention of anemia. METHODS: Type of Research: Community intervention trial study. Population study: A total of 251 toddlers aged one year old with no anemia from 6 recognized and unrecognized Bedouin villages. Intervention group: 250 toddlers who received iron supplementation; Prophylactic dosage (15 mg per day) for 6 months from the age of 1 year. Control group: 101 toddlers who did not receive iron supplementation. The hemoglobin (Hb) level was measured before and after the intervention for both groups. RESULTS: At the beginning of the study, at the age of one year there was no difference between the two groups in the average Hb level (11.8±0.5mg/dl). After the intervention of 6 months, an Hb decrease was observed in both groups: 11.5±0.8 mg/dl compared to 11.0±1.0 mg/dl in the intervention group and in the control group (p<0.001), respectively. At the study endpoint the rates of anemia in the intervention group were lower compared to the control group: 40.6% and 15.3% (p<0.001), respectively. A positive correlation was found between the toddlers Hb level and the amount of iron supplementation received through the study. CONCLUSIONS: Providing iron supplementation, from the age of 1 year for 6 months reduces the anemia risk during the second year of life. We suggest changing the recommendation to continue iron supplementation for toddlers (beyond one year old) only for children with anemia to a new policy and propose continuing iron supplementation beyond one year old to all toddlers at this age.

Simple pain measures reveal psycho-social pathology in patients with Crohn's disease.

AIM: To determine whether pain has psycho-social associations in adult Crohn's disease (CD) patients. METHODS: Patients completed demographics, disease status, Patient Harvey-Bradshaw Index (P-HBI), Short Form Health Survey (SF-36), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and five socio-psychological questionnaires: Brief Symptom Inventory, Brief COPE Inventory, Family Assessment Device, Satisfaction with Life Scale, and Work Productivity and Activity Impairment Questionnaire. Pain sub-scales in P-HBI, SF-36 and SIBDQ measures were recoded into 4 identical scores for univariate and multinomial logistic regression analysis of associations with psycho-social variables. RESULTS: The cohort comprised 594 patients, mean age 38.6 ± 14.8 years, women 52.5%, P-HBI 5.76 ± 5.15. P-HBI, SF-36 and SIBDQ broadly agreed in their assessment of pain intensity. More severe pain was significantly associated with female gender, low socio-economic status, unemployment, Israeli birth and smoking. Higher pain scores correlated positively with psychological stress, dysfunctional coping strategies, poor family relationships, absenteeism, presenteeism, productivity loss and activity impairment and all WPAI sub-scores. Patients exhibiting greater satisfaction with life had less pain. The regression showed increasing odds ratios for psychological stress (lowest 2.26, highest 12.17) and female gender (highest 3.19) with increasing pain. Internet-recruited patients were sicker and differed from hardcopy questionnaire patients in their associations with pain. CONCLUSION: Pain measures in P-HBI, SF-36 and SIBDQ correlate with psycho-social pathology in CD. Physicians should be aware also of these relationships in approaching CD patients with pain.

Effect of threatening life experiences and adverse family relations in ulcerative colitis: analysis using structural equation modeling and comparison with Crohn's disease.

BACKGROUND AND AIMS: We published that threatening life experiences and adverse family relations impact Crohn's disease (CD) adversely. In this study, we examine the influence of these stressors in ulcerative colitis (UC). PATIENTS AND METHODS: Patients completed demography, economic status (ES), the Patient-Simple Clinical Colitis Activity Index (P-SCCAI), the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), the Short-Form Health Survey (SF-36), the Brief Symptom Inventory (BSI), the Family Assessment Device (FAD), and the List of Threatening Life Experiences (LTE). Analysis included multiple linear and quantile regressions and structural equation modeling, comparing CD. RESULTS: UC patients (N=148, age 47.55±16.04 years, 50.6% women) had scores [median (interquartile range)] as follows: SCAAI, 2 (0.3-4.8); FAD, 1.8 (1.3-2.2); LTE, 1.0 (0-2.0); SF-36 Physical Health, 49.4 (36.8-55.1); SF-36 Mental Health, 45 (33.6-54.5); Brief Symptom Inventory-Global Severity Index (GSI), 0.5 (0.2-1.0). SIBDQ was 49.76±14.91. There were significant positive associations for LTE and SCAAI (25, 50, 75% quantiles), FAD and SF-36 Mental Health, FAD and LTE with GSI (50, 75, 90% quantiles), and ES with SF-36 and SIBDQ. The negative associations were as follows: LTE with SF-36 Physical/Mental Health, SIBDQ with FAD and LTE, ES with GSI (all quantiles), and P-SCCAI (75, 90% quantiles). In structural equation modeling analysis, LTE impacted ES negatively and ES impacted GSI negatively; LTE impacted GSI positively and GSI impacted P-SCCAI positively. In a split model, ES had a greater effect on GSI in UC than CD, whereas other path magnitudes were similar. CONCLUSION: Threatening life experiences, adverse family relations, and poor ES make UC patients less healthy both physically and mentally. The impact of ES is worse in UC than CD.

Effect of psychosocial stressors on patients with Crohn's disease: threatening life experiences and family relations.

BACKGROUND AND AIMS: Threatening life experiences and adverse family relations are major psychosocial stressors affecting mental and physical health in chronic illnesses, but their influence in Crohn's disease (CD) is unclear. We assessed whether these stressors would predict the psychological and medical condition of CD patients. METHODS: Consecutive adult CD patients completed a series of instruments including demography, Patient Harvey-Bradshaw Index (P-HBI), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), short-form survey instrument (SF-36), brief symptom inventory (BSI), family assessment device (FAD), and list of threatening life experiences (LTE). Associations of FAD and LTE with P-HBI, SIBDQ, SF-36, and BSI were examined by multiple linear and quantile regression analyses. RESULTS: The cohort included 391 patients, mean age 38.38±13.95 years, 59.6% women, with intermediate economic status. The median scores were as follows: P-HBI 4 (2-8), FAD 1.67 (1.3-2.1), LTE 1 (0-3), SF-36 physical health 43.75 (33.7-51.0), SF-36 mental health 42.99 (34.1-51.9), and BSI-Global Severity Index 0.81 (0.4-1.4). The SIBDQ was 47.27±13.9. LTE was associated with increased P-HBI in all quantiles and FAD in the 50% quantile. FAD and LTE were associated with reduced SIBDQ (P<0.001). Higher LTE was associated with lower SF-36 physical and mental health (P<0.001); FAD was associated with reduced mental health (P<0.001). FAD and LTE were associated positively with GSI in all quantiles; age was associated negatively. CONCLUSION: CD patients with more threatening life experiences and adverse family relations were less healthy both physically and mentally. Physicians offering patients sociopsychological therapy should relate to threatening life experiences and family relations.

Health-Related Utility Weights in a Cohort of Real-World Crohn's Disease Patients.

BACKGROUND AND AIMS: Estimating health-related utility weights in Crohn's Disease [CD] patients is crucial for assessing the cost-effectiveness of new pharmaceutical interventions. Values used in most analyses are based on secondary data and vary substantially among studies. We estimated utility weights in a consecutive sample of real-world CD patients. METHODS: Patients enrolled in an ongoing socioeconomic study of CD in the Israeli adult patient population completed a self-administered Short Form 36 health survey [SF-36] and Short Inflammatory Bowel Disease [SIBDQ] questionnaires and were assessed for their current clinical status, including the Harvey-Bradshaw Index [HBI] of disease severity. For each patient enrolled we calculated a utility weight using the SF-6D scoring system. RESULTS: The cohort comprised 425 patients [40% male] with mean age of 39.1 [± 14.0] years. The average HBI was 6.1 [± 5.4]; 198 [47%] patients were in remission state [HBI < 5], 99 [23%] had mild disease [HBI 5-7], 102 [25%] moderate [HBI 8-16], and 26 [6%] severe disease [HBI > 16]. Mean utility weights were: 0.667 in all patients, 0.744 in patients with disease remission, 0.638 in mild disease, 0.587 in moderate disease, and 0.505 in severe disease. The significant predictors of utility weights in a multivariable regression analysis were the HBI [ß = -0.494; p < 0.001], economic status [ß = 0.198; p < 0.001], time since diagnosis [ß = 0.106; p < 0.001], male [compared with female] gender [ß = 0.099; p = 0.009], hospital admission in the past year for any cause [ß = -0.086; p = 0.027], and treatment with steroids [ß = -0.100; p = 0.012] where ß denotes the standardised regression coefficients; model adjusted R(2) = 0.428. CONCLUSIONS: Utility weights for patients in the remission and mild disease states were generally lower as compared with values used in published cost-effectiveness analyses. These values should be considered when assessing the value for money of future interventions for CD.

Costs and resource utilization for diagnosis and treatment during the initial year in a European inflammatory bowel disease inception cohort: an ECCO-EpiCom Study.

BACKGROUND: No direct comparison of health care cost in patients with inflammatory bowel disease across the European continent exists. The aim of this study was to assess the costs of investigations and treatment for diagnostics and during the first year after diagnosis in Europe. METHODS: The EpiCom cohort is a prospective population-based inception cohort of unselected inflammatory bowel disease patients from 31 Western and Eastern European centers. Patients were followed every third month from diagnosis, and clinical data regarding treatment and investigations were collected. Costs were calculated in euros (€) using the Danish Health Costs Register. RESULTS: One thousand three hundred sixty-seven patients were followed, 710 with ulcerative colitis, 509 with Crohn's disease, and 148 with inflammatory bowel disease unclassified. Total expenditure for the cohort was €5,408,174 (investigations: €2,042,990 [38%], surgery: €1,427,648 [26%], biologicals: €781,089 [14%], and standard treatment: €1,156,520 [22%)]). Mean crude expenditure per patient in Western Europe (Eastern Europe) with Crohn's disease: investigations €1803 (€2160) (P = 0.44), surgery €11,489 (€13,973) (P = 0.14), standard treatment €1027 (€824) (P = 0.51), and biologicals €7376 (€8307) (P = 0.31). Mean crude expenditure per patient in Western Europe (Eastern Europe) with ulcerative colitis: investigations €1189 ( €1518) (P < 0.01), surgery €18,414 ( €12,395) (P = 0.18), standard treatment €896 ( €798) (P < 0.05), and biologicals €5681 ( €72) (P = 0.51). CONCLUSIONS: In this population-based unselected cohort, costs during the first year of disease were mainly incurred by investigative procedures and surgeries. However, biologicals accounted for >15% of costs. Long-term follow-up of the cohort is needed to assess the cost-effectiveness of biological agents.

Factors associated with childhood overweight and obesity among acculturated and new immigrants.

OBJECTIVE: To examine the relationship between acculturation and obesity among low socioeconomic status (LSES) children. DESIGN: Cross-sectional study. SETTING: Children from 12 preschools in LSES neighborhoods were recruited. PARTICIPANTS: Anthropometric measurements were obtained from 238 children (aged 4-7 years) and 224 mothers. Sociodemographic characteristics and perceptions of child's weight were collected from mothers. We compared native Israelis and immigrants for risk factors for obesity, using a 9-year cut-off to define new and acculturated immigrants. RESULTS: The combined prevalence of overweight and obesity (OWOB) among children was 29.8% (71/238) using the World Health Organization (WHO) growth standard. Mean age, sleeping hours, sex distribution and poverty level were similar between immigrants and natives. Prevalence of OWOB and current parental smoking were significantly lower among children of new immigrants (P = .02). More than 82% of mothers underestimated their child's weight status, 74.2% of OWOB children were perceived as normal-weight (NW) and 8% as thin. In a multivariable logistic-regression analysis comparing NW to OWOB children, maternal underestimation of the child's weight status (OR = 7.5; 95%CI: 3.4-16.5, P < .0001) and being born to acculturated immigrants (OR = 2.3 95% CI: 1.1-4.7, P = .03) were associated with OWOB. Ethiopian children were at lower risk for obesity. Paternal smoking increased the risk for obesity by 2-fold in non-Ethiopian, and 5-fold in Ethiopian children (OR = 2.0 and 5.0, respectively; P for interaction = .026). CONCLUSIONS: Acculturation, perception of child's weight status and parental smoking are associated with childhood OWOB. Immigration status should be considered when programs to prevent childhood obesity are implemented in mixed populations.

Adherence to mediterranean diet and decline in walking speed over 8 years in community-dwelling older adults.

OBJECTIVES: To determine the association between Mediterranean diet (MedDiet) score and 20-m walking speed over 8 years. DESIGN: Health, Aging and Body Composition Study (Health ABC) beginning in 1997/98. SETTING: Community. PARTICIPANTS: Two thousand two hundred twenty-five well-functioning individuals aged 70 and older. MEASUREMENTS: Walking speed was assessed in relation to low, medium, and high adherence to the MedDiet (0-2, 3-5, 6-9 points, respectively). RESULTS: Individuals in the highest MedDiet adherence group were more likely to be male; less likely to smoke; and more likely to have lower body mass index, higher energy intake, and greater physical activity (P < .05). Usual and rapid 20-m walking speed were highest in the high MedDiet adherence group than in the other groups (high, 1.19 ± 0.19 m/s; medium, 1.16 ± 0.21 m/s; low, 1.15 ± 0.19 m/s, P = .02, for usual speed; high, 1.65 ±0.30 m/s; medium, 1.59 ± 0.32 m/s; low, 1.55 ± 0.30 m/s, P = .001, for rapid speed). Over 8 years, usual and rapid 20-m walking speed declined in all MedDiet adherence groups. Higher MedDiet adherence was an independent predictor of less decline in usual 20-m walking speed (P = .049) in generalized estimating equations adjusted for age, race, sex, site, education, smoking, physical activity, energy intake, health status, depression and cognitive score. The effect decreased after adding total body fat percentage to the model (P = .13). Similar results were observed for MedDiet adherence and rapid 20-m walking speed; the association remained significant after adjustment for total body fat percentage (P = .01). The interaction between time and MedDiet adherence was not significant in any of the models. CONCLUSION: Walking speed over 8 years was faster in those with higher MedDiet adherence at baseline. The differences remained significant over 8 years, suggesting a long-term effect of diet on mobility performance with aging.

Adequacy of usual dietary intake and nutritional status among pregnant women in the context of nutrition transition: the DEPOSIT Study.

Bedouin Arabs in southern Israel are a traditionally semi-nomadic population undergoing the nutrition transition in a context of urbanisation. The effect of these changes on the nutritional status of pregnant women is unknown. The Dietary Exposures and Pregnancy Outcomes in a Society In Transition (DEPOSIT) study evaluated the adequacy of pregnant Bedouin women's usual dietary intake and their nutritional status. Dietary intake was assessed in a cross-sectional study design using repeat 24 h recall (24HR) questionnaires. The National Cancer Institute method was used to estimate the usual intake of selected nutrients. The Estimated Average Requirement (EAR) was used to evaluate nutrient intake adequacy. Measured weight and height data were used to calculate the participants' BMI. A total of 1109 24HR were obtained from 683 participants, of which 8 % contained no animal-source protein and an additional 43 % contained no haeme-Fe. Animal-source protein intake reached less than half of the EAR for most participants (71 %). Over 90 % had inadequate intakes of Ca, Fe, animal-source Zn, vitamin A and folate. The probability of consuming haeme-source Fe was higher among urban than rural participants (OR 1·68, 95 % CI 1·17, 2·41), and among those with employed v. unemployed husbands (OR 1·81, 95 % CI 1·27, 2·58). Only 14 % reported consuming home-produced animal products. According to pre-pregnancy BMI, 42 % were overweight or obese. The DEPOSIT study findings suggest that Bedouin Arab women are in need of interventions that address the co-existing problems of inadequate nutrient intakes and increased risk of obesity.

Bread type intake is associated with lifestyle and diet quality transition among Bedouin Arab adults.

The traditionally semi-nomadic Bedouin Arabs in Israel are undergoing urbanisation with concurrent lifestyle changes, including a shift to using unfortified white-flour bread instead of wholewheat bread as the main dietary staple. We explored associations between the transition from wholewheat to white-flour bread and (1) lifestyle factors, (2) overall diet quality, and (3) health status. We conducted a nutrition survey among 451 Bedouin adults, using a modified 24 h recall questionnaire. Bread intake accounted for 32.7 % of the total energy intake. Those consuming predominantly white bread (PWB) (n 327) were more likely to be urban (OR 2.79; 95 % CI 1.70, 4.58), eating store-bought rather than homemade bread (OR 8.18; 95 % CI 4.34, 15.41) and currently dieting (OR 4.67; 95 % CI 1.28, 17.11) than those consuming predominantly wholewheat bread (PWWB) (n 124). PWB consumption was associated with a lower intake of dietary fibre (23.3 (se 0.6) v. 41.8 (se 1.0) g/d; P < or = 0.001), a higher intake of saturated fats (26.9 v. 24.6 % of total fat; P = 0.013) and lower intakes of Fe (11.0 (se 0.3) v. 16.7 (se 0.4) mg/d), Mg (262.2 (se 5.9) v. 490.3 (se 9.8) mg/d), vitamin E (6.5 (se 0.2) v. 8.6 (se 0.3) mg/d) and most B vitamins than PWWB consumption (P < 0.001 for all), after adjusting for total energy intake. Among those aged > or = 40 years, PWB consumption was associated with a 9.85-fold risk (95 % CI 2.64, 36.71; P = 0.001) of having one or more chronic conditions, as compared with PWWB consumption, after controlling for other risk factors. White bread intake was associated with a less traditional lifestyle and poorer diet quality, and may constitute a useful marker for at-risk subgroups to target for nutritional interventions.

Role of ASCA and the NOD2/CARD15 mutation Gly908Arg in predicting increased surgical costs in Crohn's disease patients: a project of the European Collaborative Study Group on Inflammatory Bowel Disease.

BACKGROUND: NOD2/CARD15, the first identified susceptibility gene in Crohn's disease (CD), is associated with ileal stenosis and increased frequency of surgery. Anti-Saccharomyces cerevisiae antibody (ASCA), a serological marker for CD, is associated with ileal location and a high likelihood for surgery. We hypothesized that the presence of ASCA and NOD2/CARD15 mutations could predict increased health care cost in CD. METHODS: CD patients in a prospectively designed community-based multinational European and Israeli cohort (n = 228) followed for mean 8.3 (SD 2.6) years had blood drawn for measurement of ASCA (IgG, IgA), Arg702Trp, Gly908Arg, and Leu1007fsinsC. Days spent in the hospital and the costs of medical and surgical hospitalizations and medications were calculated. RESULTS: The median duration of surgical hospitalizations was longer in Gly908Arg-positive than -negative patients, 3.5 and 1.5 days/patient-year (P < 0.01), and in ASCA-positive than -negative patients, 1.1 and 0 days/patient-year (P < 0.001). Median surgical hospitalization cost was 1,580 euro/patient-year in Gly908Arg-positive versus 0 euro/patient-year in -negative patients (P < 0.01), and 663 euro/patient-year in ASCA-positive versus 0 euro/patient-year in -negative patients (P < 0.001). Differences in cost of medications between groups were not significant. The effect of Gly908Arg was expressed in countries with higher Gly908Arg carriage rates. ASCA raised surgical costs independently of the age at diagnosis of disease. Arg702Trp and Leu1007fsinsC did not affect the cost of health care. CONCLUSIONS: Since CD patients positive for Gly908Arg and ASCA demonstrated higher health care costs, it is possible that measurement of Gly908Arg and ASCA at disease diagnosis can forecast the expensive CD patients.

Diet and eating habits in high and low socioeconomic groups.

OBJECTIVE: We measured the difference of dietary intake and eating habits across socioeconomic statuses (SESs) in Israel. METHODS: Participants were randomly recruited from three high SES municipalities and three low SES municipalities in the Negev. Participants were interviewed at home with 24-h food questionnaires that included additional questions regarding health and eating habits. Nutrient and energy intakes were compared between groups, as were major contributors to the energy and food groups. RESULTS: One hundred sixteen participants from the high SES group and 206 from the low SES entered the study. Those in the low SES group were older, heavier, less educated, and less physically active. Dietary intake among the participants in the low SES group was significantly lower in protein, monounsaturated fat, and most vitamins and minerals (thiamine, riboflavin, niacin, vitamin C, calcium, magnesium, and iron). Conversely, vitamin E intake was higher in the low SES group. In the low SES group, the main contributors to energy intake were breads, oils, and sugars. Oils, fats, and citrus fruits were consumed more among subjects in the low SES group, whereas dairy products, grains, and legumes were consumed less by subjects in the high SES group. CONCLUSION: In a detailed survey conducted in two distinct populations, we found poorer diet quality in the low SES group. The root causes for such divergence need further study. As smoking declines in the modern world, nutrition will become the key risk factor in many diseases. Further research and educational and legislative initiatives are needed to curtail this risk.