Comparison of nutrient intakes of selected populations in the United States and Israel: the Lipid Research Clinics prevalence study.

Nutrient intakes of 2,772 US and 2,680 Jerusalem participants of the Lipid Research Clinics Program were assessed by 24-h dietary recall in men aged 15-19 and 40-59 yr and women aged 15-19 and 35-59 yr. Energy intake was higher in the US than in Jerusalem. In Jerusalem intake of total fat ranged between 32.2-33.7% of kcal, of saturated fatty acids (SFA) between 9.8-10.9%, of polyunsaturated fatty acids (PFA) between 7.9-8.6%, of carbohydrates between 50.5-53.9%, and of starch between 24.0-30.5%. The P:S ratio ranged between 0.80 and 1.01. The corresponding ranges for the US were 38.8-40.8% for fat, 14.3-15.9% for SFA, 5.9-6.8% for PFA, 38.9-46.2% for carbohydrates, 17.0-17.9% for starch, and 0.40-0.53 for the P:S ratio. Intake of cholesterol (mg/1000 kcal) was higher in Jerusalem than in the US. These data address the feasibility of reducing fat in diets of free-living, Western populations.

Nutrient intakes among selected North American populations in the Lipid Research Clinics Prevalence Study: composition of fat intake.

Components of fat and their relationship to total energy are described for 2,368 white male and 2,200 white female adults, aged 20-59 years, for whom 24-hour dietary recalls were completed between 1972 and 1975 in nine North American populations as a part of the Lipid Research Clinics (LRC) Program Prevalence Study. Men had higher absolute intakes of total fat and cholesterol than women, although both sexes consumed diets similar in relative composition of polyunsaturated, saturated, and monounsaturated fatty acids. Marked geographical differences in intakes of energy, total fat, and dietary cholesterol were observed. Compared with data from dietary surveys conducted in the 1960's the LRC data showed that consumption of cholesterol had decreased by the early 1970's, whereas consumption of polyunsaturated fatty acids appears to have increased, resulting in a higher ratio of polyunsaturated to saturated fatty acids. However, comparison of current dietary guidelines with these data, which are based on a single dietary recall, showed that few LRC participants met the recommendations of the Senate Select Committee on Nutrition and Human needs for dietary fat intake.

Nutrient intakes among selected North American populations in the Lipid Research Clinics Prevalence Study: composition of energy intake.

Mean energy intake and its components are presented for 4,568 white adults, 20-59 years, who participated in a population survey at nine North American Lipid Research Clinics (LRC). Nutrient intake was evaluated by a 24-hour dietary recall. Mean energy intakes ranged from 3200 kcal at age 20 to 2400 kcal at age 59 for men (2150-1650 for women). Protein intake, about 15% of energy intake, exceeded 1 g/kg body weight at all ages. Carbohydrate intake was about 40-45% of kcal, starch provided 14-20%, and estimated sucrose intake provided about 6-14%. Sex- and age-related differences varied for each macronutrient. Mean alcohol intake, for those reporting alcohol consumption, contributed 6-18% of energy for women, and 8-15% for men. Comparisons are made with data from the Health and Nutrition Examination Survey I and from the USDA Nationwide Food Consumption Survey, with the Recommended Dietary Dietary Allowances, and with the Dietary Goals.

Body mass, fat distribution and cardiovascular risk factors in a lean population of south China.

The associations of body mass index and abdominal adiposity, represented by an elevated waist/hip circumference ratio, with cardiovascular risk factors were examined in men and women, aged 28-69 years, from urban and rural areas of Guangzhou, China. Mean body mass index ranged from 20.1 to 21.9 kg/m2 across the four sex- and area-groups. Mean waist/hip ratio was 0.84 in men and 0.80 in women. After accounting for age and body mass index, waist/hip ratio was associated negatively (p < 0.05) with fasting serum HDL cholesterol (both sexes), and positively with serum triglycerides (both sexes), total and LDL cholesterol (men only), uric acid (both sexes), glucose (women only), and mean systolic blood pressure (women only). Body mass index was associated in a similar direction with most of these risk factors. These data confirm that abdominal adiposity is independently associated with cardiovascular disease risk factors, even in a lean Asian population.

The relationship between dietary factors and serum lipids in Chinese urban and rural populations of Beijing and Guangzhou. PRC-USA Cardiovascular and Cardiopulmonary Research Group.

BACKGROUND: Serum cholesterol (TC) levels and coronary heart disease (CHD) are lower in China than in western countries. This report examines the role of diet in determining TC. METHODS: Data were collected as part of a cross-sectional study of 10,000 men and women, 35-54 years old, conducted in 1983-1984 in four areas in China. A 10% subsample was surveyed for eating patterns and measurement of blood lipids. Six one-day dietary recalls were collected on each participant. RESULTS: Mean daily intake of energy from fat was less than 30%. Mean Keys scores ranged from 20.4 to 32.6. In multivariable regression analysis controlling for age, body mass index (BMI), and alcohol, Keys score was statistically associated with serum TC. A 10-unit greater Keys score was associated with 6.3 mg/dl higher TC and 4.0 mg/dl higher low density lipoprotein cholesterol. CONCLUSIONS: We conclude that in China the relation of dietary factors to serum lipids is similar to that in populations having high serum TC levels.

The association of education with coronary heart disease mortality in the USSR Lipid Research Clinics Study.

There is a strong inverse association between educational attainment and coronary heart disease (CHD) mortality in men in the USSR Lipid Research Clinics (LRC) Study. Less educated men were characterized by higher mean blood pressure, high density lipoprotein cholesterol (HDL-C), cigarettes smoked and by lower mean low density lipoprotein cholesterol (LDL-C) and body mass index (BMI). With respect to nutritional variables, less educated men were characterized by higher mean energy per kg body weight and alcohol intake and by lower mean intake of fat, saturated, mono- and polyunsaturated fatty acids, cholesterol, sucrose, and other sugars. The Keys score closely predicted the differences in plasma cholesterol among the educational groups in the randomly selected sample. In men without CHD at entry, the age and clinic-adjusted relative risk for CHD mortality was 2.4 for the least educated compared with the most educated group; on adjusting for systolic blood pressure, HDL-C, LDL-C, BMI, alcohol intake and number of cigarettes, the relative risk was reduced to 1.9. These data indicate that only 22% of the twofold excess of CHD mortality associated with low education was statistically attributable to the major risk factors. The failure to explain more of the education-CHD mortality gradient in the USSR LRC cohort was similar to observations from cohort studies in Great Britain and the US. Other correlates of low education must be explored to explain the association.

Food group system of analysis with special attention to type and amount of fat--methodology.

A system for reporting dietary data in terms of food groups is described. The scheme was developed jointly by the National Heart, Lung, and Blood Institute (NHLBI) and the U.S. Department of Agriculture to identify food use patterns in various population groups. The system comprises 14 major groups and 75 minor groups based on major nutrient composition with special attention to fats. One-day dietary recalls from 5,640 participants in the Lipid Research Clinics (LRC) Prevalence Study were analyzed to determine the frequency of food group usage by males and females in age groups 6 to 9, 10 to 19, 20 to 59, and 60 and older. Food group use is reported as percent of the population reporting use as obtained by the dietary recall as well as the average number of times each food group was mentioned by the users. LRC food selection patterns are compared with the Dietary Guidelines. Findings in this report indicate that, for the LRC population, some of the foods emphasized in the guidelines are not eaten with a high degree of frequency.

Diet design for a multicenter controlled feeding trial: the DELTA program. Delta Research Group.

OBJECTIVE: To describe the process and results of diet standardization, diet validation, and monitoring of diet composition, which were key components of protocol 1 of Dietary Effects on Lipoproteins and Thrombogenic Activity (DELTA-1), the initial protocol in a program of multicenter human feeding studies designed to evaluate the effects of amount and type of fat on lipoproteins and hemostasis parameters in various demographic groups. DESIGN: DELTA-1 was based on a randomized, blinded, crossover experimental design. Three diets were fed for 8 weeks to 103 healthy men and women aged 22 to 67 years at 4 field centers. Diet A, an average American diet, was designed to provide 37% of energy from fat, 16% of energy from saturated fatty acids (SFAs); diet B (step 1 diet) was designed to provide 30% of energy from fat, 9% of energy from SFA; and diet C (low SFA diet) was designed to provide 26% of energy from fat, 5% of energy from SFA. Key features of diet standardization included central procurement of fat-containing foods, inclusion of standard ingredients, precision weighing of foods--especially sources of fat and cholesterol--and use of standardized written procedures. SETTING: For menu validation, a set of 12 menus for each diet was prepared in duplicate and chemically assayed. For monitoring of diet composition during the study, an 8-day diet cycle (6 weekday and 2 weekend menus) was sampled by every field center twice during each of 3 feeding periods. STATISTICAL ANALYSES: Means (+/- standard error) were calculated and compared with target nutrient specifications. RESULTS: DELTA-1 was able to provide a standardized diet that met nutrient specifications across 4 field centers over 24 weeks of participant feeding spanning a total of 8 months. APPLICATIONS: Prestudy chemical validation of menus and continuous sampling and assay of diets throughout the study are essential to standardize experimental diets and to ensure that nutrient target goals are met and maintained throughout a controlled multicenter feeding study.

Weight gain and its correlates in Poland between 1983 and 1993.

BACKGROUND: Weight gain and its unfavorable consequences on coronary heart disease (CHD) risk have been observed worldwide. Determinants of weight gain were studied in a Polish cohort of 1042 men and women age 35-64 at baseline. Participants were randomly selected from an urban population in Warsaw and a rural population in Tarnobrzeg Province surveyed by investigators in Krakow. The surveys, part of the Pol-MONICA project, were conducted in 1983-1984, 1987-1988, and 1992-1993. The purpose of this report is to gain insight into the dynamics of weight gain in this population that could be helpful in identifying high-risk groups for intervention, and to determine if economic changes that took place shortly after the second survey had any impact on weight gain. METHODS: Weight, height and demographic characteristics were measured at each visit according to Pol-MONICA standard protocol. Body mass index (BMI) was calculated as kg/m2. Years of schooling, 7-day alcohol history and smoking history were self-reported. RESULTS: Sixty percent of the cohort gained some weight, averaging 0.3-0.7kg/y. Weight gain was highest in younger rural women, in urban men and in rural women with low education. In multiple linear regression, low education was related to a 1.29 kg greater weight gain (P<0.01), ex-smoking status was related to a 2.54 kg greater weight gain (P<0.001), and younger age was related to a 1.14 kg greater weight gain (P<0.001). CONCLUSION: Our results indicate a need to target intervention programs at young low SES adults. Developing effective means of reaching these vulnerable groups is a critical research goal.

Cognitive and attitudinal impacts of a university AIDS course: interdisciplinary education as a public health intervention.

This paper describes an interdisciplinary, variable credit-bearing university course on acquired immunodeficiency syndrome (AIDS) that enrolled 429 students. Pre- and post-course questionnaires were used to assess knowledge and attitudes relative to AIDS and these were compared to National Health Interview Survey findings. Considerable cognitive and attitudinal changes occurred over the course period. University courses, taught annually, were found to be an efficient mechanism for educating large numbers of future community leaders and professionals about AIDS.

Nutrient intake in Jerusalem--effects of origin, social class and education.

The independent association of ethnic group, social class and education with nutrient intake was studied in a sample of 1,294 adults in the Jerusalem Lipid Research Clinic (LRC) population. By univariate analysis, intake of fat and saturated fatty acids (SFA) was higher (P less than or equal to 0.05) in males and females of the upper social classes (classified by the occupation of the head of the family) than in the lower classes, while the opposite trend was found for the consumption of carbohydrates and starch. In men, an association between social class and the intakes of protein and other carbohydrates (i.e., other than sucrose and starch) and the ratio of polyunsaturated fatty acids (PFA) to SFA (P:S ratio) was also found. In both sexes, the mean intakes of SFA and other carbohydrates were higher and that of starch lower in subjects with a higher level of education (P less than or equal to 0.05). Education was also associated with the consumption of protein and fat in males and with that of carbohydrates and sucrose in females. Country of origin was related (P less than or equal to 0.05) to the intake of fat, SFA and other carbohydrates in both sexes, to that of protein and cholesterol in males and to that of carbohydrates, sucrose and starch in females. The P:S ratio of the diet of male subjects was also associated with origin. Using various models of analysis of variance, it was shown that origin was associated with nutrient intake (P less than or equal to 0.10), independent of the effect of social class and education for protein, fat, SFA, cholesterol, sucrose and other carbohydrates in males, and for fat, SFA, PFA and other carbohydrates in females. The P:S ratio of the male diet was also associated with origin. The level of education was independently related (P less than or equal to 0.10) to the intake of fat, SFA, starch and other carbohydrates in males and to that of sucrose in females, while social class was associated independently with carbohydrate consumption in males only. After prior adjustment for origin, education had a stronger residual effect than did social class in males, while in females the associations of social class and education with nutrient intake were almost identical.

An evaluation of the sensitivity of five home pregnancy tests to known concentrations of human chorionic gonadotropin.

A study was conducted to evaluate the sensitivity of the five commercially available home pregnancy testing kits. Known amounts of human chorionic gonadotropin (hCG) were diluted in pooled, sterile male urine. Varying concentrations of hCG were randomly assigned to 100 kits of each of the five brands. The test results were read independently by three individuals who were blinded to the hCG concentrations. Statistical analysis were based on the majority vote of the readers. The rank-ordered sensitivity of the five home pregnancy tests, expressed as the proportion of positive results for the range of hCG concentrations studied, was as follows: (1) Predictor, (2) e.p.t., (3) Acu-Test, (4) Answer, and (5) Daisy 2. Overall, Predictor and e.p.t. appear to be more accurate than Acu-Test or Answer. Only Daisy 2 was found to be significantly different from the other brands. However, the currently marketed Daisy 2 pregnancy test is manufactured by a different company.

Changes in food, nutrient and energy intake in People's Republic of China samples of urban and rural north and south adults surveyed in 1983-84 and resurveyed in 1987-88.

Dietary patterns were assessed in a prospective study of cardiovascular disease (CVD) risk factors in four Chinese populations: Beijing urban (BJ-U) and rural (BJ-R), Guangzhou urban (GZ-U) and rural (GZ-R). A total of 10,076 men and women 35-54 years old were surveyed in 1983-84 and resurveyed in 1987-88. Dietary data were obtained in a subsample of about 10% (n=169 BJ-U, 178 BJ-R, 198 GZ-U, 230 GZ-R). Three 24-hr recalls were collected on each participant in each survey. Comparison of mean intakes in the two periods showed increases in meat, poultry, fish (except GZ-R), eggs (rural only), milk (except BJ-R) and alcoholic beverages. The largest shifts were in meat intake (29%-39%), alcoholic beverages (71%-104%) and fats in the urban samples (33%-35%). These changes are reflected in increased mean intakes of animal protein, fat, saturated fatty acids (SFA) and higher Keys scores. Mean total fat intake now exceeds the PRC recommended range of 20-25% of energy in three of the four samples. During this period BMI increased in all samples especially among men (3% - 6%). These surveys, conducted during a period of rapid economic development in China, show that such changes promote shifts in dietary patterns and energy balance towards increased risk of cardiovascular disease.

Plasma high-density lipoprotein cholesterol, total cholesterol and triglyceride levels in 17-year-old Jewish residents of Jerusalem: a preliminary report. The Lipid Research Clinics Program Prevalence Study.

Preliminary data on plasma high-density lipoprotein (HDL) cholesterol, total cholesterol and triglyceride levels in 2565 teenage Jerusalem residents attending a military medical examination were analyzed. Mean HDL cholesterol levels were highest among male and female subjects whose fathers had immigrated from Europe and the Americas and lowest in those of Asian and of North African origin. Second-generation Israelis ranked intermediate between the Europeans and the other two groups. Total cholesterol levels were lowest in teenagers of both sexes whose fathers had come from North Africa, highest in subjects of European and of Israeli origin and intermediate in the Asians. Triglyceride levels were also lowest among North Africans of both sexes, but the Asian and Israeli groups had higher mean values than the Europeans. These findings show that patterns of lipid and lipoprotein levels previously observed in adult immigrants persist in a generation of native-born Israelis.

Nutrient intake in Jerusalem--consumption in 17-year-olds.

The food intake of 17-yr-old Jerusalem residents was assessed in a random sample, including 627 males and 551 females, by a 24-h dietary recall method. The intake of energy in boys and girls was lower than the recommended energy intake for this age, but the intake relative to body weight was low only in girls. In boys and girls, the intakes of fat relative to energy were 32.4 and 33.7%, respectively; those of saturated fatty acids (SFA) (9.8 and 10.5%) were lower and those of carbohydrates (53.9 and 52.5%) were higher than intakes found in other Western countries. The P:S (polyunsaturated to saturated fatty acids) ratio of their diets was high and ranged from 0.79 to 1.29 in various sex and origin groups. Intake of cholesterol per 1,000 kcal was similar to that in Western countries. There were marked differences in nutrient intake of subjects whose fathers had immigrated from different countries. Boys whose fathers were born in Israel or Europe had higher intakes of fat and cholesterol, and both boys and girls had a higher intake of SFA and a lower intake of carbohydrates and starch as well as a lower P:S ratio than did their counterparts whose fathers were born in Asia and North Africa. Thus, the nutrient intake of youngsters in Jerusalem differs markedly from that of populations in other Western countries.

Nutrient intake in Jerusalem--consumption in adults.

During 1976-80, nutrient intake was assessed in a cross-sectional sample of 1,589 middle-aged Jerusalem residents (1,028 males and 561 females) using the protocols and methods of the North American Lipid Research Clinics (LRCs) Prevalence Studies. All subjects were parents of 17-yr-old youngsters studied previously. Energy intake in both males and females was lower than the recommended energy intake for this age-group. Intake of fat relative to energy in males and females was 32.1 and 34.0%, of saturated fatty acids (SFA) 10.0 and 11.0%, and of total carbohydrates 50.2 and 49.9%, respectively. Cholesterol consumption was 210 and 238 mg/1,000 kcal in males and females, respectively. The mean polyunsaturated to saturated fatty acids (P:S) ratio of the diet was 0.95 in males and 0.84 in females. There were marked differences in the nutrient intake of subjects of different ethnic origin. Subjects from Israel and Europe consumed more total fat and SFA and less total carbohydrates than did their counterparts from Asia and North Africa. Consumption of polyunsaturated fatty acids (PFA) was highest in subjects from Israel. The P:S ratio of the diet was highest in the North African group, followed by the Israeli group, and lowest in subjects from Europe. The highest sucrose intake was found in subjects from North Africa and the highest cholesterol intake in immigrants from Europe. Nutrient intake of Jerusalem adults differed markedly from that of populations in other Western countries.

The relationship between dietary factors and serum lipids in southern Chinese population samples.

As part of the PRC-USA collaborative research project on the epidemiology of cardiovascular disease, baseline surveys were conducted in four random urban and rural samples in Guangzhou, Guangdong Province in southern China on 334 men and women aged 35-54 in the fall of 1983-84 with the aim of studying the correlation between dietary intakes and serum lipids. Methods standardized by the US Centers for Disease Control were used for measuring different parameters, and quality control was emphasized to assure comparability between workers and farmers. Three 24-hour recalls were collected from each participant in each survey. Mean values of daily intakes of nutrients per capita for the four groups were as follows: 59-69% kcal carbohydrate; 10-12% kcal protein; 22-26% kcal fat. Dietary total fat, saturated fatty acid (SFA), polyunsaturated fatty acid (PUFA) and cholesterol were higher in the urban than the rural areas. Mean levels of serum total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were 4.6 mmol/l, 1.1 mmol/l, 1.3 mmol/l and 2.8 mmol/l respectively. The TC, TG and LDL-C and HDL-C were significantly higher in the urban than the rural areas. Analyses of correlation showed that the Keys 'dietary lipid score' was positively associated with TC, LDL-C and HDL-C; specifically, dietary cholesterol was positively associated with serum TC. Saturated fatty acids (SFA) and monounsaturated fatty acids (MUFA) were positively correlated with HDL-C. It seems that the traditional dietary pattern of Guangzhou favours serum lipids being at an optimal level.

Associations of fish intake and dietary n-3 polyunsaturated fatty acids with a hypocoagulable profile. The Atherosclerosis Risk in Communities (ARIC) Study.

Recent epidemiological evidence indicates that the hemostatic profile is an important predictor of cardiovascular disease, yet its dietary determinants are not well established. An important question is whether dietary fatty acid intake influences blood levels of coagulation proteins. We examined potential dietary determinants of six hemostatic factors--fibrinogen, factor VII, factor (vWF), protein C, and antithrombin III--in four population-based samples totaling over 15,000 participants, blacks and whites, in the Atherosclerosis Risk in Communities (ARIC) Study. Usual dietary intake was assessed by a food frequency questionnaire. Cross-sectional associations were explored using multiple linear regression analysis, adjusting for gender, race, age, body mass index, smoking status, alcohol use, diabetes, and field center. Dietary intake of n-3 polyunsaturated fatty acids (PUFAs) showed negative associations with fibrinogen, factor VIII, and vWF (blacks and whites) and a positive association with protein C (whites only). Fish intake, the major source of dietary n-3 PUFAs, was similarly related to the hemostatic profile: a 1 serving per day greater fish intake was associated with the following predicted differences (95% confidence interval): fibrinogen, -2.9 mg/dL (-6.3, 0.5); factor VIII, -3.3% (-5.4, -1.3); vWF, -2.7% (-5.2, -0.1) (blacks and whites); and protein C, +0.07 microgram/mL (0.03, 0.11) (whites only). Other nutrients or foods were variably associated with the hemostatic factors. These population-based associations, although cross-sectional, suggest that increases in n-3 PUFA intake from fish may modify the blood levels of several coagulation factors.