Coeliac disease: the association between quality of life and social support network participation.

BACKGROUND: There is little information available on the use of social support systems for patients with coeliac disease (CD). We performed a cross-sectional study aiming to examine the association between participation in different types of social support networks and quality of life (QOL) in adults with CD. METHODS: A survey including a validated CD specific QOL instrument was administered online and in-person to adults with CD who were following a gluten-free diet. Participation in social support networks (type, frequency and duration) were assessed. RESULTS: Among the 2138 participants, overall QOL scores were high, averaging 68.9 out of 100. Significant differences in QOL scores were found for age, length of time since diagnosis and level of education. Most (58%) reported using no social support networks. Of the 42% reporting use of social support networks (online 17.9%, face-to-face 10.8% or both 12.8%), QOL scores were higher for those individuals who used only face-to-face social support compared to only online support (72.6 versus 66.7; P < 0.0001). A longer duration of face-to-face social support use was associated with higher QOL scores (P < 0.0005). By contrast, a longer duration and increased frequency of online social support use was associated with lower QOL scores (P < 0.03). CONCLUSIONS: Participation in face-to-face social support networks is associated with greater QOL scores compared to online social support networks. These findings have potential implications for the management of individuals with CD. Emphasis on face-to-face support may improve long-term QOL and patient outcomes.

Short-term patient-centered nutrition counseling impacts weight and nutrient intake in patients with systemic lupus erythematosus.

BACKGROUND: Patients with systemic lupus erythematosus (SLE) are at a high risk for cardiovascular disease (CVD) due to increased prevalence of traditional and nontraditional CVD risks factors. OBJECTIVE: To evaluate the effect of patient-centered nutrition counseling methods on changes in select nutrient, anthropometric, and clinical outcomes in SLE patients enrolled in a CVD prevention counseling program (CVD PCP). METHODS: From March 2009 to June 2011 a subgroup of SLE patients enrolled in our CVD PCP were referred to a registered dietitian for individualized nutrition counseling. Outcomes of interest were assessed at baseline and six months. A primary analysis evaluated the six-month changes in nutrient intake, weight, body mass index (BMI), waist circumference, and lipid levels. A secondary analysis compared the same measurements between the nutrition counseling patients and the group that was referred but did not attend. RESULTS: Of 71 referrals, 41 (58%) attended nutrition counseling (female: 89%, African American/Hispanic: 72%, mean age of 39.7 ± 12.82 years, and a mean disease duration of 11.49 ± 8.02 years). Over a six-month period, patients attending nutritional counseling: (a) reduced their intake of sodium (p = 0.006), total calories (p = 0.07), and percent calories from fat (p = 0.011) and saturated fat (p = 0.068); (b) had decreased weight (-1.64 kg, p = 0.025); and (c) were more likely to report increases in eating a diet rich in fruits and vegetables (p < 0.001), a high fiber diet (p = 0.011), ≥two servings of fish/week (p = 0.002), and a low cholesterol diet (p = 0.034). There were no significant changes observed over the six months in BMI and clinical outcomes among nutrition counseling patients. When comparing nutrition counseling patients to those who were referred but did not attend, we found at six months a higher percentage of nutrition counseling patients reportedly followed a high-fiber diet (p = 0.03), consumed two or more servings of fish per week (p = 0.01), followed a low-cholesterol diet (p = 0.03), and achieved a greater weight loss (p = 0.04) compared to the group that did not attend. CONCLUSION: At six months we found that nutrition counseling using patient-centered methods appears to be an effective method for promoting changes in nutrient intake, diet habits, and, possibly, anthropometric measures in SLE patients. However, the counseling did not show a significant improvement in lipid levels, possibly due to short follow-up and/or SLE related factors.

Post-diagnosis family adaptation influences glycemic control in women with type 2 diabetes mellitus.

Family adaptation to type 2 diabetes management after nutrition education was studied as part of a 2.5-year ethnography. Data analysis included descriptive data (observations, transcribed audio recordings, written field notes) and quantitative data (self-monitored morning fasting blood glucose, food records) from the families of 5 New York suburban women. The following inferences emerged from data analysis. Among the women with improved glycemic control, the home and family routines had changed. Diabetes management was observed as certain tasks: food tasks, patient care tasks, management tasks, and medical advice tasks. The social context of the women's daily lives influenced their glycemic control; specifically, family members other than the women with diabetes took on new "hospital roles and routines." Nutrition education should be directed toward assessing existing family social support and helping women organize and supplement this support to ensure the successful completion of the tasks of diabetes self-management.

Usefulness of psychosocial theory variables in explaining fat-related dietary behavior in Chinese Americans: association with degree of acculturation.

OBJECTIVE: To determine the usefulness of variables from psychosocial models of health behavior in explaining fat-related dietary behavior among a sample of Chinese Americans. DESIGN: A survey questionnaire was administered to a convenience sample of Chinese Americans and analyzed for descriptive statistics and relationships among variables. SUBJECTS/SETTINGS: Participants were 600 healthy individuals, ranging from 25 to 70 years of age, living in New York City. VARIABLES MEASURED: Demographic factors, degree of acculturation, food preferences, and 13 social psychological scales derived from the Theory of Planned Behavior, the Healthy Belief Model, and Social Cognitive Theory. Dependent measures assessed were intention to reduce dietary fat and behaviors related to the selection of reduced-fat diets. STATISTICAL ANALYSES: Descriptive statistics, Pearsons' correlation coefficients, t-tests, one-way analyses of variance, and multiple regression analyses were used. RESULTS: Attitude, overall health concern, and self-efficacy accounted for 58% of the variance in behavioral intention for the entire sample. Attitude, perceived barriers, and self-efficacy accounted for 19% of the variance in the prediction of dietary fat reduction behaviors. In general, a gradient was seen in the increased predictiveness of each regression model by degree of acculturation of the immigrants to American culture: predictiveness (R2) for behavior ranged from 15% for the least to 34% for the most acculturated. Acculturation was significantly related to declines in the influence of habit and of social norms. These effects were not seen by length of residency. IMPLICATIONS: Nutrition educators should assess the degree of acculturation of groups with whom they work and recognize that the degree of acculturation impacts the relative importance of various psychosocial variables in fat reduction behaviors.

Adolescents' perspectives and food choice behaviors in terms of the environmental impacts of food production practices: application of a psychosocial model.

The objective of this study was to investigate adolescents' perspectives about the environmental impacts of food production practices and whether these perspectives are related to their food choice. Food choice was operationalized as consumption and purchase of organic foods and locally grown foods. A survey questionnaire was administered to a convenience sample of adolescents and analyzed for descriptive information and relationships among variables. Subjects were 651 ethnically diverse, urban and suburban high school senior students in a major metropolitan area. Variables of an Expanded Theory of Planned Behavior were measured including beliefs, attitudes, perceived social influences, motivation to comply, perceived behavioral control, self-identity, perceived responsibility, behavioral intention, and behavior. Descriptive statistics, Pearson correlation coefficients, and stepwise multiple regression analyses were used. Surveyed adolescents did not have strong or consistent beliefs or attitudes about the environmental impact of food production practices. Cognitive-motivational processes were at work, however, since their perspectives were significantly correlated with behavioral intentions and food choice behaviors. Behavioral intention was best accounted for by attitudes and perceived social influences (and perceived responsibility for organic food), and behavior was best accounted for by behavioral intentions, beliefs, and perceived social influences (and self-identity for local food). There is a need to make salient to adolescents the environmental impact of food production practices through both cognitive and experiential approaches.

Restrained eating among adolescents: dieters are not always bingers and bingers are not always dieters.

This study examined individual differences in the relationships among 3 constructs relevant to restrained eating theory-cognitive restraint (dieting), disinhibition (binging), and hunger. Participants were 421 adolescents (158 male, 255 female, and 8 not indicated). Comparisons among subgroups based on scores on the 3 constructs indicated that there were (a) 2 types of frequent dieters-those who follow theoretical predictions and become disinhibited and those who maintain their restraint; (b) 2 types of bingers-those who engage in dieting-induced binging and those who are hungry and disinhibited; and (c) 2 types of low-hunger eaters-those who suppress their hunger and those who eat before they experience much hunger. Implications of the results for restrained eating theory are discussed.

Reducing cancer risk among Native American adolescents.

BACKGROUND: This article discusses the development, implementation, and preliminary testing of an intervention to reduce cancer risks through tobacco use prevention and dietary modification among Native American youth in the Northeastern United States. METHODS: The intervention outcome study includes a research design and outcome measurement instruments. In collaboration with Native American communities, reservations, and organizations in the Northeastern United States, implementation of the design quantifies the separate and combined effects of a tobacco use prevention and a dietary modification intervention. RESULTS: Native American youths in the tobacco prevention intervention and in the combined tobacco and dietary intervention increased their knowledge of tobacco facts and their awareness of the motives of tobacco advertising, and showed higher ratings for an ability to resist peer pressure and to refuse offers of tobacco use between pretest and posttest. Youths in the combined intervention were significantly less apt to report smoking of any kind. Youths in the tobacco use prevention-only condition reported significantly less smoking than their counterparts in the dietary modification-only condition and control condition on 4 of 8 measurement items. As for dietary variables, pretest to posttest measurement scores showed that, after receiving the curriculum, youths in the dietary modification intervention and in the combined intervention improved their knowledge of the health implications of consuming dietary fat, fiber, fruits, and vegetables. Youths in the dietary modification and combined intervention also improved their scores of knowledge related to cancer risk-reducing nutritional practices, cultural dietary habits, and healthy food choices available for Native American cultures. Youths in the dietary modification-only condition report significantly increasing their consumption of complex carbohydrates and significantly decreasing their fat intake between pretest and posttest occasions. CONCLUSIONS: Data from this longitudinal study suggest the value of the FACETS curriculum for helping Native American youth reduce their risks for cancer associated with tobacco use and dietary preference and consumption patterns. In particular, results indicate the enhanced effects of the combined tobacco use prevention and dietary modification intervention for preventing tobacco use and for improving youths' knowledge and attitudes with regard to tobacco use and diet. Further, the study demonstrates the value of collaborating with Native American organizations to design a cancer risk-reducing curriculum and to implement tests of that curriculum.

Adolescent food choice criteria: role of weight and dieting status.

The purpose of this study was to examine the relation of weight status, dieting status and several associated variables to the criteria for everyday food choice used by adolescents. Study participants were 411 students between the ages of 11 and 18, drawn from 15 schools. The adolescents rated 20 food in terms of nine food attributes (how tasty or healthful specific foods were, whether the foods were eaten by friends, and so forth). Within-person correlation coefficients were then calculated between these ratings and actual food choices as measured by a food frequency scale. The relation of weight and dieting status, as predictors of each of these correlational indices of the importance of potential food choice criteria, was then analysed using hierarchical multiple regression. In similar fashion, the relation was examined between weight and dieting status and: evaluations of food attributes (choice criteria); dietary quality; calorie, sugar and fat intake; body image; and physical activity. For a majority of food choice criteria and other variables, there was an apparent influence of weight as an independent variable. However, when dieting status was analysed simultaneously with weight, similar and stronger effects were now seen for dieting status and the effects of weight disappeared. Although some of the differences as a function of dieting status resembled differences shown previously in relation to dietary restraint, it is noteworthy that the simpler dieting variable yielded these associations. Overall, a "psychology of dieting" seems more relevant than "psychology of being fat versus being thin". This psychology appears to involve cognitive self-regulation processes. It is thus crucial that intervention programs and research studies take into account both the dieting status and the weight status of participants.

The rate of increase in blood pressure in children 5 years of age is related to changes in aerobic fitness and body mass index.

OBJECTIVE: To determine whether changes in aerobic fitness and body mass index are related to the age-related rise in blood pressure in healthy preschool children. STUDY DESIGN: Longitudinal analyses of 196 free-living children aged 5 years at baseline who were followed over a mean of 19.7 months. Aerobic fitness was assessed using a treadmill. All measures were obtained on multiple occasions at scheduled visits as part of a longitudinal cohort study. SETTING: An inner-city medical center. OUTCOME MEASURES: Blood pressure was measured using an automated Dinamap device. RESULTS: Mean systolic blood pressure was 95.3 mmHg (SD 8.38) at baseline and increased by 4.46 mmHg per year. Mean diastolic blood pressure was 53.9 mmHg (SD 5.81) at baseline and did not change significantly. Children in the highest quintile of increase in fitness had a significantly smaller increase in systolic blood pressure compared to children in the lowest quintile (2.92 vs 5.10 mmHg/year; P = .03). Children in the lowest quintile of increase in body mass index did not differ significantly in rate of increase in systolic blood pressure compared to children in the highest quintile (3.92 vs 4.96 mmHg/year). In a multiple regression model including baseline systolic blood pressure, fitness, height, body mass index, and other covariates, greater increase in fitness (P = .03) and lesser increase in body mass index (P < .01) were associated with lower rates of increase in systolic blood pressure. In a similar multivariate analysis, an increase in fitness was also associated with a lower rate of increase in diastolic blood pressure (P = .02). CONCLUSION: Young children who increase their aerobic fitness or decrease their body mass index reduce the rate of the age-related increase in blood pressure. These observations may have implications for development of interventions directed at the primary prevention of hypertension.

Assessing changes in nutrient intakes of preschool children: comparison of 24-hour dietary recall and food frequency methods.

Methods for assessing change in the habitual diet of children are essential for diet intervention studies as well as clinical management. Food frequency questionnaires are a potential alternative to recall and record methods, which require multiple days of data collection for stable individual estimates of habitual intake. Over 3 years, we studied 173 children (93% Hispanic; baseline age 44-60 months) in New York City. We obtained dietary data by interviewing the child's mother. We calculated intakes of nine nutrients, expressed as nutrient densities, as the mean of two administrations of the Willett food frequency questionnaire and the mean of three administrations of the 24-hour dietary recall in years 1 and 3. The two methods consistently estimated the direction of change in mean nutrient density of total and polyunsaturated fat, cholesterol, carbohydrate, and potassium. Changes in nutrient density assessed by the two methods correlated poorly (r < or = 0.15) for all nine nutrients. Cross-classification analysis also showed no relation between change assessed by recall and food frequency methods. Lack of between-person variability could not explain the low correlations, as individual changes in nutrient density were large.

Is there a relationship between dietary fat and stature or growth in children three to five years of age?

STUDY OBJECTIVE: To determine whether a moderately reduced fat diet affects the stature or growth of healthy preschool children. DESIGN: Cohort study with mean of 25 months of follow-up. SETTING: Primary care pediatrics practice at a large urban medical center. SUBJECTS: A predominantly Hispanic group of 215 children aged 3 to 4 years at baseline. MEASUREMENTS AND MAIN RESULTS: The children's diet was assessed using four 24-hour recalls and three Willett semiquantitative food-frequency questionnaires administered to the children's mothers over a 1-year baseline period. Stature was defined in terms of height, weight, and body mass index at baseline. Growth was defined in terms of change during follow-up in height, weight, and body mass index. Total fat provided a mean of 27.1% of caloric intake in the lowest quintile of intake compared with 38.4% in the highest quintile. There were no differences in stature or growth across quintiles of children defined by consumption of total fat, saturated fat, or cholesterol. These findings were consistent across the two methods of diet assessment. Children who consumed a smaller percentage of total calories from fat consumed significantly less total calories, saturated fat, cholesterol, calcium, and phosphorus, as well as more carbohydrates, iron, thiamine, niacin, vitamin A, and vitamin C. CONCLUSIONS: These data support the safety of a moderately reduced fat diet in healthy preschool children. Maintenance of calcium and phosphorus intake should be part of any program of dietary fat reduction. Substitution of low-fat milk for whole milk, rather than elimination of whole milk, is one such strategy.

Relationship of mothers' food choice criteria to food intake of preschool children: identification of family subgroups.

This study investigated the relationship between potential criteria mothers use to select foods for their children, their food knowledge, and food consumption of their children. Participants were 218 predominantly Latino mothers and their 4 to 5-year-old children. Mothers rated 17 foods in terms of 10 food attributes (how tasty specific foods were to their child, whether they were convenient to prepare, etc.). Within-person correlation coefficients were then calculated between these ratings and reported frequency of consumption of these same 17 foods. These correlations were then used in a k-means cluster analysis to identify six distinct subgroups of families, who had different orientations ranging from "high health" to "high taste." Children in the "high health" groups had diets significantly lower in calories, fat, saturated fat, and sucrose and higher in fiber and vitamin A from 24-hour dietary recalls reported by mothers. Mothers' health knowledge was also correlated with nutrient takes of children. These data indicate that families can be segmented according to the importance of beliefs about healthfulness of foods and that this segmentation predicts quality of diet of children. This study suggests that interventions should be designed to increase mothers beliefs in the importance of health in choosing foods. For those mothers whose food choices are dominated by children's tastes, interventions should be directed at how to prepare healthful foods to taste good to children.

A formative evaluation of the American Cancer Society Changing the Course nutrition education curriculum.

A formative evaluation was conducted of Changing the Course, a behaviorally oriented, activity-based nutrition education curriculum for elementary students from the American Cancer Society, to assess feasibility of program implementation. Sixteen teachers in six schools in the Northeast taught the 15-16 session lower and upper elementary curricula to 702 students. Teacher satisfaction with the curriculum was high. Fidelity of implementation of the curriculum also was high and relatively few modifications to learning activities were made. Teachers reported the one day of training they received was adequate. They also reported a positive influence of the curriculum on themselves and their students. Student achievement results showed most children achieved most of the learning objectives at posttest--80% giving the correct answers on more than 75% of the test items. An examination of children's item-by-item answers on the posttest and of teachers' logs provided information useful for the final stages of development of the curricula and teacher training procedures, before national dissemination.

Variability and self-regulation of energy intake in young children in their everyday environment.

Recent data from small numbers of children studied under controlled protocols indicate that intraindividual variation in energy consumption over 24 hours is smaller than variation from eating occasion to eating occasion, implying that children self-regulate their energy consumption. This hypothesis was tested in children living in their everyday environment. Between 1986 and 1989, 24-hour recalls were administered on seven occasions (four times in 1986 through 1987 and three times in 1988 through 1989) to the mothers of 181 preschool children in New York City. Each 24-hour period was divided into six meals or snacks. The coefficient of variation (standard deviation divided by the mean) was calculated for each child for energy consumption at each eating occasion and for the day as a whole. Coefficients of variation for energy consumption at the six eating occasions ranged from 46.5% to 165.8%, compared with 30.3% for the whole day. This coefficient of variation for the observed whole-day energy consumption was significantly less (P < .001) than would be expected if no autoregulation of energy intake (no meal-to-meal correlation) occurred. These findings in children living in their everyday environment are consistent with observations under more controlled study conditions. These data suggest that children who eat less at one meal compensate at another, although the data do not address the issues of longer term energy self-regulation, overall energy balance, or diet quality.

Consistency of the Willett semiquantitative food frequency questionnaire and 24-hour dietary recalls in estimating nutrient intakes of preschool children.

A study was performed to determine the utility of the Willett semiquantitative food frequency questionnaire for assessing the habitual diets of preschool children. Children (n = 224) were recruited mainly through a New York City hospital-based pediatric practice during 1986-1987. The children's ages at baseline were 44-60 months; 50% were male, and 91% were Hispanic. Over a 12-month period, the Willett food frequency questionnaire was administered twice to each child's parent, and a 24-hour dietary recall was conducted four times. For energy and eight nutrients, group mean intakes derived from food frequency questionnaires were 1.4-1.9 times higher than those from 24-hour recalls. Group mean estimates of nutrient density of total and saturated fat, potassium, and calcium did not differ between the two methods. Correlations between methods for crude nutrient intakes (unadjusted for energy consumption) ranged from 0.16 (polyunsaturated fat in boys) to 0.60 (potassium in girls). Correlations generally decreased when intakes were adjusted for energy consumption. Adjustment for energy intake and residual intraindividual variability yielded correlations of 0.48 for total calories, 0.35 for total fat, and 0.37 for saturated fat. For intake of energy and nine nutrients, of those children classified into the highest quintile by dietary recall, 28.9-40.9% were so classified by the Willett questionnaire, and 48.9-68.9% were classified into the highest two quintiles. When data were expressed as nutrient densities, agreement was high for potassium and calcium and fair for saturated fat, cholesterol, and protein. The moderately low consistency of nutrient intake estimates across dietary assessment methods in this study may be due, in large part, to residual intraindividual variability in both the recall data and the food frequency data.

Variability and tracking of nutrient intakes of preschool children based on multiple administrations of the 24-hour dietary recall.

The authors measured intra-individual day-to-day variation and tracking of nutrient intakes among 181 preschool children (53% male, 45-60 months of age at baseline, 93% Hispanic) recruited through a hospital-based pediatrics practice in New York City. From 1986 to 1989, 24-hour dietary recalls were administered on seven occasions (four times in year 1 and three times in year 3) to the children's mothers. Median follow-up (midpoint of year 1 to midpoint of year 3) was 19.3 months. The reliability of estimates (intraclass correlation coefficients) of energy and nine nutrients obtained from a single administration of the dietary recall ranged from 0.15 to 0.38. Based on unadjusted nutrient intakes, 33.1-55.6% of children in the top quintile of intake at year 1 remained in the top quintile, and 58.3-83.3% in the top two quintiles, at year 3. Of the children in the lowest quintile at year 1, 27.8-50.0% were in the lowest quintile and 55.6-80.6% in the lowest two quintiles at year 3. Consistency of classification decreased when intakes were adjusted for energy intake. Correlations between mean energy and unadjusted nutrient intakes at year 1 and year 3 ranged from 0.27 to 0.45. When energy intake was controlled, correlations decreased for most but not all nutrients (range, 0.09-0.59). Correction of correlations of energy and energy-adjusted nutrients for residual intra-individual variation yielded correlations between mean intakes at year 1 and year 3 in the range 0.15 to 0.71. These data indicate that despite considerable residual intra-individual day-to-day variability of dietary intakes there is substantial tracking of underlying diets among preschool children over a 19-month period.

Relationships of dietary fat consumption to serum total and low-density lipoprotein cholesterol in hispanic preschool children.

BACKGROUND: Studies of the relationship between dietary fat intake and serum lipids in young children have yielded inconclusive results. We studied this relationship in 108 Hispanic children ages 4-5 years. METHODS: Four 24-hr recalls approximately 3 months apart and two Willett semiquantitative food frequency questionnaires approximately 6 months apart were obtained by interviewing the children's mothers. Diet measures were averaged for the multiple administrations of each of these instruments. RESULTS: Based on the 24-hr recalls, children in the highest tertile of total fat consumption (36.2% of total calories) compared with the lowest tertile (30.2% of total calories) had mean total serum cholesterol of 4.32 mmol/liter (167 mg/dl) vs 3.91 mmol/liter (151 mg/d) (test for linear trend across tertiles, P less than 0.05) and mean low-density lipoprotein cholesterol of 2.74 mmol/liter (106 mg/dl) vs 2.29 mmol/liter (89 mg/dl) (test for linear trend, P less than 0.01). Children in the highest tertile of saturated fat consumption (14.6% of total calories) compared with the lowest tertile (11.2% of total calories) had mean total serum cholesterol of 4.39 mmol/liter (170 mg/dl) vs 3.97 mmol/liter (154 mg/dl) (test for linear trend, P less than 0.05) and mean low-density lipoprotein cholesterol of 2.80 mmol/liter (108 mg/dl) vs 2.35 mmol/liter (91 mg/dl) (test for linear trend, P less than 0.01). These relationships remained significant when calorie-adjusted nutrient intakes were examined and after adjustment in multiple linear regression models for age, sex, and body mass index, with the exception of the association of calorie-adjusted total fat with total serum cholesterol level (P = 0.07). Similar results were obtained using the Willett questionnaires. CONCLUSIONS: These findings indicate that dietary fat, particularly saturated fat consumption, is an important correlate of blood lipid levels in preschool children. These are also the first reported data indicating that the Willett questionnaire, as a method for measuring the atherogenic components of diet, has criterion-related validity in young children.

Resting metabolic rate and energy balance in amenorrheic and eumenorrheic runners.

This study investigated metabolic and nutritional factors in association with athletic menstrual dysfunction (AMD). Three groups of women were studied: amenorrheic runners (amenorrheic), eumenorrheic runners (eumenorrheic), and eumenorrheic sedentary controls (sedentary). Amenorrheic and eumenorrheic were similar in age, weight, percent body fat by hydrodensitometry, training pace and mileage, best 10 km race time, years running, and maximal oxygen consumption. When adjusted for body weight or for fat-free mass by analysis of covariance, RMR was significantly lower in amenorrheic than in eumenorrheic and sedentary. The daily caloric intakes of the groups did not differ significantly, but the amenorrheic scored significantly higher than the eumenorrheic and sedentary on a scale of aberrant eating patterns. Amenorrheic high mileage runners seem to have a less adequate diet than eumenorrheic runners but appear to maintain energy balance and stable weight through a reduction in RMR.