Development and Evaluation of a Manganese and Iron Food Frequency Questionnaire for Pediatrics.

Manganese (Mn) is an essential nutrient, but overexposure can lead to neurotoxicity. Given the essentiality of Mn in the diet, particularly during children's growth and development, it is imperative to quantify dietary Mn intake in populations that may be exposed to industrial sources of Mn. Dietary absorption of Mn is inversely associated with iron (Fe) stores, yet there is currently no food frequency questionnaire (FFQ) to assess dietary Mn and Fe intake. The study objective was to develop and evaluate the validity of a FFQ to measure dietary Mn and Fe intake in pediatrics by comparing the estimated intakes of Mn and Fe with biomarkers: Mn in blood and hair and Fe in serum. This study utilized a subset of the Communities Actively Researching Exposure Study (CARES) population residing in Guernsey County, Ohio. Dietary Mn was not correlated with either blood or hair Mn; however, dietary Mn and serum ferritin were significantly correlated, with a correlation coefficient of 0.51, p < 0.01. Moreover, dietary Fe and serum ferritin were also significantly correlated, with a correlation coefficient of 0.51, p < 0.01. This FFQ is a valid measurement tool for Fe intake as measured by serum ferritin; however, Mn intake did not correlate with either blood or hair Mn.

Social capital, social support, and food insecurity in food pantry users.

The purpose of this study was to examine the relationship between food security, social capital, and social support among urban food pantry users in Cincinnati. In-person interviews with 53 participants were completed using the U.S. Household Food Security Survey Module, Social Capital questionnaire, and Social Support questionnaire. Social capital was assessed through four subscales using a Likert scale, with a response range 1 to 4, and social support was measured by rating significant others' emotional, informational, and instrumental support as well as companionship (ranged from 0 to 4). The findings suggested that there were no significant associations among them. This may be due to a small sample size. Thus, the associations need to be examined with a larger sample. Further, a qualitative approach may be necessary to explore the contextual nature of social capital and social support related to food security.

Longitudinal study of nutrient intakes in infants aged 12 to 18 months.

OBJECTIVE: To examine the nutrient intakes in young children and to compare their intakes with the dietary reference intakes (DRIs). DESIGN: Longitudinal study observing the child's food and beverage intakes as he or she grows from 12 to 18 months. METHODS: Three interviewer-administered 24-hour dietary recalls over 1 week were collected from the mother to assess the child's intakes at 12 and 18 months of age. Intakes were calculated at the 10th, 25th, 50th, 75th, and 90th percentiles and compared with the DRIs to determine the proportions below and above cutoff values. RESULTS: Nutrient intakes met or exceeded energy and nutrient requirements, with some exceptions. Diets were deficient in healthy fats, iron, fiber, and potassium and excessive in calories, synthetic folate, preformed vitamin A, zinc, and sodium. CONCLUSIONS: Health professionals should emphasize foods that are nutrient dense while decreasing highly processed foods for children.

Nutrition education for postpartum women: a pilot study.

This pilot study examined the effectiveness of a 4-month clinic-based dietary intervention emphasizing the intake of deep yellow and dark green vegetables versus usual care on improving diet quality in postpartum women. The intervention group (n = 31) received 1 face-to-face nutrition education session with a registered dietitian, 2 follow-up phone calls, and 3 pamphlets distributed by mail. The usual care group (n = 25) received handouts with guidelines on healthy eating. Dietary outcomes were assessed from 3-day food recalls and evaluated using paired and independent t tests. Intervention women exhibited a significant increase in total vegetable intake (P < .001) and in dark green and deep yellow vegetables (P < .001). In comparison, the control group increased the intake of total vegetables (P < .001), but did not increase the consumption of dark green and deep yellow vegetables. When comparing the change in intake between study groups for both types of vegetables, the difference was not significant. Furthermore, 61% of the intervention women met the goals for total vegetable intake compared with 12% for the usual care group (P < .001). The intervention group also had a greater percentage of women (25.8%) that met the goal for deep yellow and dark green vegetable intake when compared with the usual care group (8%; P < .08). These results suggest that postpartum women are receptive to nutrition education and that nutrition education can influence vegetable intake.

Sociocultural influences on the determinants of breast-feeding by Latina mothers in the Cincinnati area.

While breast-feeding initiation and duration among US Latina women appear to decrease with acculturation, health care providers in the Greater Cincinnati area have noted lower rates of breast-feeding among even first-generation Latina immigrants. This study's purpose was to identify determinants of breast-feeding for Latina mothers in Cincinnati through qualitative interviews and Spanish Breastfeeding Self-Efficacy Scale ratings. Our findings suggest that, along with similar levels of breast-feeding self-confidence, foreign-born Latina women in the Greater Cincinnati area share similar breast-feeding determinants with the general population. However, characteristics of these determinants and their impact vary because of unique pressures experienced by this community.

Assessing dietary variety in children: development and validation of a predictive equation.

BACKGROUND: Research indicates that the length of time needed to describe dietary diversity is approximately 2 weeks. This is the first study conducted to develop a dietary variety measurement tool that is sensitive to the effect of time on dietary variety without the burden of gathering data for 2 weeks. OBJECTIVE: To determine whether 3 days of 24-hour dietary recall logs collected during a 15-day period would predict food variety as well as 15 consecutive days. The study also determined which set of 3 days (consecutive vs interval days) within a 15-day period would better predict 15-day food variety. DESIGN: Prospective survey of the dietary practices of children. SUBJECTS/SETTING: Seventy-two children aged 9 to 12 years attending fourth and fifth grades in a public elementary school in a Midwestern town in the fall of 2005. MAIN OUTCOME MEASURES: Predicted 15-day cumulative dietary variety score from 3 consecutive days and 3 interval days of dietary data. STATISTICAL ANALYSIS PERFORMED: Two prediction models were obtained from multiple linear regression analyses in which natural log-transformed (log(e)) 15-day variety scores were regressed on log(e) 3-day variety scores (consecutive and interval days). The ability of each model to predict the 15-day cumulative variety score was assessed by comparisons of mean bias, mean-squared error, coefficient of determination (R(2)), and Pearson product-moment correlation coefficients. RESULTS: Three days of dietary data accurately estimated dietary variety over time for this sample of 9- to 12-year-old children using the predictive equation generated in this study. Three interval days predicted 15-day food variety more precisely than 3 consecutive days. CONCLUSIONS: The predictive equation is accurate in estimating food variety over time for this population and, if validated in independent samples, could be applied to similar populations.

The efficacy of a clinic-based behavioral nutrition intervention emphasizing a DASH-type diet for adolescents with elevated blood pressure.

OBJECTIVE: To examine the efficacy of a 3-month clinic-based behavioral nutrition intervention emphasizing a diet high in fruits, vegetables, and low fat dairy (DASH intervention) versus routine outpatient hospital-based nutrition care (RC) on diet and blood pressure (BP) in adolescents with elevated BP. STUDY DESIGN: Fifty-seven adolescents with a clinical diagnosis of prehypertension or hypertension (systolic BP or diastolic BP, 90(th) to 99(th) percentile) were randomly assigned to DASH or RC. SBP, DBP, 3-day diet recall, weight, and height were assessed at pretreatment, post-treatment, and 3 months later (follow-up). RESULTS: In completer analysis, DASH versus RC had a greater decrease in SBP z scores from baseline to post-treatment (P < 0.01) and a trend for a greater decrease in SBP z scores from baseline through follow-up (P = .07). DBP z scores changed similarly for conditions from baseline through follow-up. Relative to RC, DASH had a greater increase in intake of fruits (P < .001), potassium and magnesium (P < .01), and a greater decrease in total fat (P < .05) from baseline to post-treatment. From baseline through follow-up, DASH versus RC had a greater increase in low fat dairy (P < .001). CONCLUSIONS: The DASH intervention proved more effective than RC in improving SBP and diet quality in adolescents with elevated BP.

Short-term exposure to a high-protein diet differentially affects glomerular filtration rate but not Acid-base balance in older compared to younger adults.

There is conflicting evidence regarding the effects of high protein intake on kidney health, especially as it relates to age. We investigated the short-term effects of a high-protein diet on kidney function and systemic acid-base homeostasis in older compared to younger adults. The subjects were healthy men and women either between the ages of 25 and 40 years (n=12) or 55 and 70 years (n=10). They underwent a two-period crossover trial with each period consisting of 2 weeks of usual diet followed by a 1-week experimental diet. During the experimental diet period subjects consumed metabolic meals that provided either low protein content (0.5 g protein/kg/day) or high protein content (2.0 g protein/kg/day). Outcome measures included blood and urine markers of renal function and acid-base balance. An analysis of variance was used to assess differences between age groups with respect to experimental diet. The older group, mainly women, showed an increase in glomerular filtration rate after the high-protein compared to low-protein diet; the younger group did not. Urinary pH was significantly lower, and ammonium excretion was significantly higher after the high-protein diet in both age groups, but neither group developed a clinically detectable acidosis after the week of receiving a high-protein diet.

A clinical-based intervention improves diet in patients with head and neck cancer at risk for second primary cancer.

A diet rich in fruits and vegetables is associated with a reduced risk of head and neck cancer. This study was designed to assess the efficacy of an intervention to increase fruit and vegetable consumption and improve overall diet quality in patients with early stage head and neck cancer at risk for second primary cancer. The study was a crossover-controlled design with each patient being his or her own control. Patients received usual care during the control period followed by a clinical-based intervention grounded in the Social Learning Theory for 3 months. Measurements were taken at baseline, 6 months, and 12 months. The intervention consisted of a face-to-face counseling session, a phone call, and three mailings. Findings from this study indicate that these patients increased their intake of fruits (number of servings and variety), vegetables (number of servings), and improved overall diet quality while exposed to the intervention as compared with usual care.

Dietary variety increases as a function of time and influences diet quality in children.

OBJECTIVE: To investigate the changes in dietary variety over time in children and to determine the relationship between dietary variety and diet quality. DESIGN: Dietary data were collected from fourth and fifth grade students for 14 consecutive days by a registered dietitian. SETTING: Colerain School District of Cincinnati, Ohio. PARTICIPANTS: There were 33 children involved in the study. MAIN OUTCOME MEASURES: Two cumulative dietary variety scores were estimated. The first was based on the Food Guide Pyramid groups: grain, fruit, vegetable, dairy, and meat (GFVDM). The second was based on the groups highlighted by the 2000 Dietary Guidelines for variety: grain, fruit, and vegetable (GFV). Diets were analyzed for energy and nutrient content. ANALYSIS: Analysis of variance and Pearson correlation coefficients. RESULTS: Dietary variety increased over time up to 14 days. A significant difference (P <.0001) was found for the cumulative GFVDM and GFV variety scores on days 3, 7, and 14. Positive correlations were found between the GFVDM and GFV variety scores and vitamin C and fiber. CONCLUSIONS AND IMPLICATIONS: This study suggests that a 2-week period is necessary to capture food variety in children. Some associations were found between dietary variety and diet quality. New tools are needed to measure dietary variety in children.

Dietary antioxidant intake in patients at risk for second primary cancer.

OBJECTIVES: To analyze dietary antioxidant intake for head and neck cancer patients at risk for development of second primary cancers. STUDY DESIGN: Prospective observational study. METHODS: Twenty-four patients underwent three random, unscheduled, 24-hour dietary recalls over a 15-day period within 6 to 60 months after successful treatment for stage I or II oral cavity squamous cell carcinoma. RESULTS: The study sample had a lower mean daily dietary intake of fruits and vegetables and antioxidant nutrients, including vitamins A, C, E, and total carotenes than age- and sex-matched historic control subjects (all P <.05 except vitamin A). A positive linear correlation was noted between daily servings of F&V and dietary intake of vitamins A, C, E, and total carotenoids (all P <.05 except vitamin A). Compared to current recommendations, the study sample had lower mean daily dietary intake of vitamins A, C, and E (P =.81,.06, and <.01) and servings of fruits and vegetables (P <.01). When vitamin supplements were included in the analysis, mean daily intake exceeded recommended dietary allowance (RDA) for vitamins A, C, and E (all P <.05). CONCLUSION: This study suggests that patients treated for early-stage oral cavity carcinoma, at risk for second primary cancers, have a statistically significant deficiency in dietary (food) sources of antioxidant nutrients when compared with both historic control subjects and current recommendations. Vitamin supplementation significantly exceeded current RDAs. Because increased fruit and vegetable intake, but not vitamin supplementation exceeding RDA, is associated with reduced cancer risk, physicians may consider recommending at least five daily servings of fruits and vegetables as an alternative to vitamin supplementation.

Role of antioxidant nutrients and lipid peroxidation in premature infants with respiratory distress syndrome and bronchopulmonary dysplasia.

The objective of this study was to determine if newborn premature infants with severe respiratory distress syndrome (RDS) who developed bronchopulmonary dysplasia (BPD) demonstrate, within the first 3 days of life, lower blood levels of antioxidants and higher urine levels of lipid peroxidation products than premature infants who recovered from RDS. Perinatal variables (gestational age, birth weight, and Apgar scores) and antioxidant indices in cord and in third day of life plasma and red blood cell (RBC) samples from healthy premature infants (n = 35), infants with RDS (n = 23) and infants with BPD (n = 23) were examined. Antioxidant indices included selenium, alpha-tocopherol, total and oxidized glutathione, glutathione peroxidase, superoxide dismutase, and urinary malondialdehyde. By inferential statistics, only the perinatal variables and cord plasma selenium distinguished healthy premature infants from premature infants with RDS or BPD. From perinatal variables and antioxidant indices we calculated: (1) cord to third-day-of-life variable differences, (2) variable-to-variable ratios, and (3) ratios of a difference for one variable to a difference for any second variable. Subset regression analysis yielded an equation (adjusted R2 = 0.8839) that correctly predicted infants who developed BPD 100% of the time. Predictor variables for BPD were gestational age, Apgar at 1 min, cord and third-day-of-life RBC selenium, cord total glutathione, cord and third-day-of-life glutathione peroxidase and nine different ratios involving Apgar scores, RBC selenium, total and oxidized glutathione, alpha-tocopherol, glutathione peroxidase, and superoxide dismutase. In this study, there was no relationship between lipid peroxidation and BPD. There was a higher rate of patent ductus arteriosus, congestive heart failure, and retinopathy of prematurity in infants with BPD. This study confirms that low plasma selenium and alpha-tocopherol levels in premature infants (< or = 30 weeks' gestational age or lower) were significantly associated with an increased respiratory morbidity.

A curriculum based on social learning theory emphasizing fruit exposure and positive parent child-feeding strategies: a pilot study.

This study examined the effectiveness of a nutrition intervention program to enhance children's knowledge, preference, and intake of whole fruit and to decrease parents' use of controlling child-feeding behaviors. Subjects were fifth- and sixth-grade students (children aged 10-12 years) from Cincinnati, Ohio. Nine parent-child pairs completed the study. Seventeen parent-child pairs who expressed interest but were unable to attend more than one session served as controls. Based on the Social Learning Theory, the curriculum combined child-focused interactive lessons and skill-building activities with parent-focused lessons on child-feeding strategies to increase the fruit intake of children. Change in children's knowledge, preference, and intake of fruit and parents' use of controlling child-feeding strategies were measured in a pretest/posttest manner using validated questionnaires. There was a significant increase in knowledge scores and fruit intake by children in the experimental vs the control group. Fruit preference scores were similar between groups. Additionally, there was a significant decrease in use of controlling child-feeding strategies by parents in the intervention vs the control group.