Suboptimal nutritional intake for hypertension control in 4 ethnic groups.

BACKGROUND: This study compared intake of specific nutrients based on the Dietary Approaches to Stop Hypertension (DASH) guidelines for hypertension management among multiethnic middle-aged and older adults. METHODS: We conducted quantitative analysis using baseline data of a prospective cohort study of 5972 adults aged 45 to 84 years recruited between July 2000 and August 2002 who participated in the Multi-Ethnic Study of Atherosclerosis (MESA). Diet information was collected using a 120-item food frequency questionnaire. Bivariate and multivariate methods were used to evaluate associations between DASH-accordant intake of each nutrient (fat, saturated fat, cholesterol, protein, fiber, calcium, magnesium, and potassium) with ethnicity and hypertension status. RESULTS: Less than 30% of MESA participants met any DASH nutrient target. DASH accordance was lowest in saturated fat intake and highest in cholesterol intake (5.3% and 29.5% of the participants, respectively). Multivariate analyses showed significant ethnic differences in DASH accordance in all nutrients but saturated fat. Compared with white participants, Chinese American participants had greater DASH accordance in cholesterol (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.13-1.67) and protein intake (2.32; 1.55-3.49) but less in total fat (0.47; 0.30-0.74), magnesium (0.58; 0.51-0.67), and potassium intake (0.40; 0.20-0.81); African Americans and Hispanics had greater DASH accordance in fiber intake (1.36; 1.13-1.62; and 2.23; 1.53-3.23, respectively) but less in calcium intake (0.44; 0.37-0.52; and 0.79; 0.68-0.91, respectively). Diagnosed and uncontrolled hypertension was associated with less DASH accordance in saturated fat (OR, 0.80; 95% CI, 0.70-0.91) and magnesium (0.80; 0.71-0.91). DASH accordance differed significantly with and without inclusion of dietary supplements in the analysis. CONCLUSIONS: There is significant variation in DASH goal attainment among different ethnic groups. Assessments of nutrient intake that exclude dietary supplements may be underestimating DASH accordance.

Evaluating clinically meaningful change on the ITP-PAQ: preliminary estimates of minimal important differences.

OBJECTIVE: Interpretation of data from health-related quality of life (HRQoL) questionnaires can be enhanced with the availability of minimally important difference (MID) estimates. This information will aid clinicians in interpreting HRQoL differences within patients over time and between treatment groups. The Immune Thrombocytopenic Purpura (ITP)-Patient Assessment Questionnaire (PAQ) is the only comprehensive HRQoL questionnaire available for adults with ITP. RESEARCH DESIGN AND METHODS: Forty centers from within the US and Europe enrolled ITP patients into one of two multicenter, randomized, placebo-controlled, double-blind, 6-month, phase III clinical trials of romiplostim. Patients enrolled in these studies self-administered the ITP-PAQ and two items assessing global change (anchors) at baseline and weeks 4, 12, and 24. Using data from the ITP-PAQ and these two anchors, an anchor-based estimate was computed and combined with the standard error of measurement and standard deviation to compute a distribution-based estimate in order to provide an MID range for each of the 11 scales of the ITP-PAQ. RESULTS: A total of 125 patients participated in these clinical trials and provided data for use in these analyses. Combining results from anchor- and distribution-based approaches, MID values were computed for 9 of the 11 scales. MIDs ranged from 8 to 12 points for Symptoms, Bother, Psychological, Overall QOL, Social Activity, Menstrual Symptoms, and Fertility, while the range was 10 to 15 points for the Fatigue and Activity scales of the ITP-PAQ. These estimates, while slightly higher than other published MID estimates, were consistent with moderate effect sizes. CONCLUSIONS: These MID estimates will serve as a useful tool to researchers and clinicians using the ITP-PAQ, providing guidance for interpretation of baseline scores as well as changes in ITP-PAQ scores over time. Additional work should be done to finalize these initial estimates using more appropriate anchors that correlate more highly with the ITP-PAQ scales.

Modifications to the Healthy Eating Index and its ability to predict obesity: the Multi-Ethnic Study of Atherosclerosis.

BACKGROUND: The Healthy Eating Index (HEI) is a measure of diet quality developed based on the Dietary Guidelines for Americans (DGA). OBJECTIVE: The objective was to assess the diet quality of a multi-ethnic population using and comparing the 2 HEIs, the updated HEI (HEI-05) based on the 2005 DGA and the original 1990 HEI (HEI-90), with the objective of predicting obesity outcomes. DESIGN: A longitudinal analysis of survey and clinical data from 6236 middle-aged and elderly white, African American, Hispanic, and Chinese participants of the Multi-Ethnic Study of Atherosclerosis (MESA) was conducted. Baseline diet quality was assessed with the use of HEI-90 and HEI-05. Baseline and 18-mo follow-up body mass index (BMI) and waist circumference (WC) data were predicted by using z score multiple regression models, and categorical obesity status was predicted by using multinomial logistic regression. RESULTS: Overall, the HEI-05 had larger z score beta coefficients than did the HEI-90 (eg, in whites, -0.53 compared with -0.48 in baseline BMI, -0.54 compared with -0.47 in follow-up BMI, -1.67 compared with -1.56 in baseline WC, and -1.57 compared with -1.44 in follow-up WC). Among whites only, both HEIs were significant predictors of BMI and WC (all P < 0.001). The odds of being obese rather than normal weight were inversely related to HEI z scores primarily in whites (P < 0.05). CONCLUSIONS: The changes to the 2005 DGA, as reflected by HEI-05, appear to better predict obesity outcomes in this multi-ethnic population, primarily in whites. Additional research on ethnic-specific DGA adherence and its relation to health outcomes is needed.

Deteriorating dietary habits among adults with hypertension: DASH dietary accordance, NHANES 1988-1994 and 1999-2004.

BACKGROUND: Although the DASH (Dietary Approaches to Stop Hypertension trial) diet is among the therapeutic lifestyle changes recommended for individuals with hypertension (HTN), accordance with the DASH diet is not known. METHODS: Using data from the National Health and Nutrition Examination Survey (NHANES) from the 1988-1994 and 1999-2004 periods, DASH accordance among individuals with self-reported HTN was estimated based on 9 nutrient targets (fat, saturated fat, protein, cholesterol, fiber, magnesium, calcium, sodium, and potassium) (score range, 0-9). Using data from 1999-2004, we compared the DASH score among demographic groups in age- and energy-adjusted models and modeled the odds of a DASH-accordant dietary pattern (>or=4.5) using multivariable logistic regression. The DASH score, DASH accordance, and percentage of participants achieving individual targets were compared with estimates from NHANES 1988-1994 data. RESULTS: Based on 4386 participants with known HTN in the recent survey period (1999-2004), the mean (SE) DASH score, after adjustment for age and energy intake, was 2.92 (0.05), with 19.4% (1.2%) classified as DASH accordant. In multivariable logistic regression models, DASH accordance was associated with older age, nonblack ethnicity, higher education, and known diabetes mellitus. Accordance with DASH was 7.3% lower in the recent survey period compared with NHANES 1988-1994 (26.7% [1.1%]) (P < .001), reflecting fewer patients with HTN meeting nutrient targets for total fat, fiber, and magnesium. CONCLUSION: The dietary profile of adults with HTN in the United States has a low accordance with the DASH dietary pattern, and the dietary quality of adults with HTN has deteriorated since the introduction of the DASH diet, suggesting that secular trends have minimized the impact of the DASH message.

Impact of chronic Immune Thrombocytopenic Purpura (ITP) on health-related quality of life: a conceptual model starting with the patient perspective.

BACKGROUND: Immune thrombocytopenic purpura (ITP), a condition characterized by autoimmune-mediated platelet destruction and suboptimal platelet production, is associated with symptoms such as bruising, epistaxis, menorrhagia, mucosal bleeding from the gastrointestinal and urinary tracts and, rarely central nervous system bleeding. The aim of this research is to develop a conceptual model to describe the impact of ITP and its treatment on patients' health-related quality of life (HRQoL). METHODS: A literature search and focus groups with adult ITP patients were conducted to identify areas of HRQoL affected by ITP. Published literature was reviewed to identify key HRQoL issues and existing questionnaires used to assess HRQoL. Focus group transcripts were reviewed, and common themes were extracted by grouping conceptual categories that described the impact on HRQoL. RESULTS: The literature synthesis and themes from the focus group data suggest that decreased platelet counts, disease symptoms, and treatment side effects influence multiple domains of HRQoL for ITP patients. Key areas affected by ITP and its treatments include emotional and functional health, work life, social and leisure activities, and reproductive health. CONCLUSION: ITP affects various areas of HRQoL. This conceptual model will help inform the evaluation of therapeutic strategies for ITP.