Carmen Castaneda

A Home-Based Nutrition Intervention to Increase Consumption of Fruits, Vegetables, and Calcium-Rich Foods in Community Dwelling Elders

OBJECTIVE To increase fruit, vegetable, and calcium-rich food consumption in community-dwelling, functionally impaired elderly. DESIGN Six-month, home-based nutrition intervention study. SUBJECTS Seventy men and women older than age 69 years were randomized to either a nutrition education intervention (n = 38) or a control group that received an exercise intervention (n = 32). INTERVENTION Nutrition education was designed to increase fruit, vegetable, and calcium-rich food consumption. MAIN OUTCOME MEASURES Food intake was assessed by a food frequency questionnaire. Fasting blood measures of nutrients and carotenoids were performed. Statistical Analysis Two-group randomized controlled trial with pre-test and post-test design and intention-to-treat analysis. Analysis of covariance to was used to assess differences between the two groups. Baseline and change partial correlation coefficients were performed between intake and blood nutrient levels. Paired t tests were conducted to test within-group changes. RESULTS Compared with the exercise group, subjects in nutrition group increased their self-reported intake of fruits by 1.1 +/- 0.2 (mean +/- SEM) servings per day (2.8 to 3.9, P = .01), vegetables 1.1 +/- 0.2 servings per day (2.3 to 3.4, P = .001), and milk/dairy 0.9 +/- 0.2 servings per day (3.0 to 3.9, P = .001). There was an increase in the dietary intake of alpha-carotene and beta-carotene in the nutrition group and this correlated with the increase in blood concentrations of alpha-carotene and beta-carotene (P < or = .02; r = 0.33 and r = 0.33, respectively). CONCLUSION The results of this study suggest that it is possible to improve the dietary intake of community dwelling elders to include more fruits, vegetables, and calcium-rich foods. Recommendations for increasing consumption of fruits, vegetables, and calcium-rich foods should be specific and individualized to meet the dietary pattern and lifestyle of the individual. Compliance should be encouraged with record keeping as well as through continuous monitoring and positive reinforcement.

The energy expenditure of postmenopausal women classified as restrained or unrestrained eaters.

Objective: Restrained eating is a common dietary practice among individuals who are attempting to prevent weight gain, but little is known about differences in energy physiology and regulation between restrained and unrestrained eaters. We investigated this issue in non-obese free-living postmenopausal women classified as long-term restrained (n=26) or unrestrained (n=34) eaters group matched for body mass index (BMI).Measurements: Measurements were made of total energy expenditure (TEE), resting energy expenditure (REE), body composition, reported leisure time activity, maximal aerobic capacity (VO2max) and weight change during the study period. In addition, physical activity level (PAL) and nonexercise activity thermogenesis (NEAT) were calculated from measured variables.Results: There were no significant differences between the groups in body composition, weight change, aerobic capacity or total leisure time activity. Relationships between fat-free mass (FFM) and both REE and TEE, and the relationship between work load and energy expenditure in the test of maximal oxygen consumption, were also not different between groups. However, restrained eaters had a significantly lower PAL (equal to TEE/REE, 1.72±0.04 vs 1.84±0.04, P<0.05). In addition, in multiple regression models predicting NEAT, NEAT was significantly lower in restrained eaters than unrestrained eaters and there was a positive relationship between NEAT and weight change in unrestrained eaters but no relationship in restrained eaters (P<0.05).Conclusions: In contrast to a previous report, we found no significant difference in TEE between restrained and unrestrained eaters. PAL was slightly lower in restrained eaters, apparently due to reduced NEAT, and restrained eaters also lacked the positive association between NEAT and body weight change seen in unrestrained eaters. This latter finding, if confirmed in future studies, could help explain an increased susceptibility of restrained eaters to weight gain.Sponsorship: NIH grants AG12829, DK46124 and T32AG00209, and US Cooperative Agreement number 58-1950-9-001.European Journal of Clinical Nutrition (2001) 55, 1059–1067

Haematological status of school children in two regions of Guatemala : relevance of normality standards

Haematocrit values of 1484 Guatemalan children aged 5 to 18 years (mean: 10 years), 897 males and 587 females, were determined in a haematological survey. Five hundred and eight were sampled in the highland province of Alta Verapaz (AV) and 976 in the coastal province of Retalhuleu (Reu). Packed cell volumes were classified as ‘normal’ or ‘subnormal’ using two published standards, both adjusted by age, gender, and altitude of origin (Interdepartmental Committee for Nutrition in National Development, 1969; Viteri et al, 1972). The former gave a global prevalence of haematological subnormality of 7.7%: 10.6% in AV and 6.3% in Reu; the latter gave a global prevalence of 8.0%: 16.1% in AV and 6.3% in Reu. The lowland population, paradoxically, had the lower rate of low haematocrits. Males had more subnormal haematocrits than females. Only 37 of 196 children (19%) were identified as having a haematological deficit by both systems simultaneously. For assessment of the haematological status of the Guatemalan pop...

Food Records Vs Urine Urea Nitrogen in Assessing Adherence to a Low- Protein Diet in Early Stage Chronic Renal Insufficiency.

Abstract LEARNING OUTCOME: To measure adherence of subjects prescribed a low protein diet using an individualized approach and frequent counseling. Individuals with early stage chronic renal insufficiency (CRI) may benefit from a low protein diet. We investigated the effects of exercise in protein-restricted subjects with CRI aged 48–79 y (mean=64±11 y) who were recruited from the greater Boston area who had a mean baseline serum creatinine of 2.9±1.0mg/dl and mean GFR of 32.9±27.3ml/min. Six subjects were prescribed a low protein diet (0.6g/kg adjusted body wt/d); the mean adherence period was 4±1 wks. Subjects were seen individually by a research dietitian 2x/wk for about 30–60 min/visit. Food records (FR) were recorded by patients 6 d/wk and analyzed using Nutritionist IV version 4.0. Twenty-four hour urine was collected 2x/wk to measure urine urea nitrogen (UUN) by the enzymatic method. FR and UUN showed a significant decrease in protein intake at the start of adherence period. Mean FR and UUN for protein intake were 82.78±26.14g/d (0.98 ± 0.13g/kg body wt/d) and 74.0±36.0g/d (0.86± 0.31g/kg body wt/d) respectively. At the end of adherence period, approximately 4 wks later, mean protein intake by FR was 39.89±11.49g/d (0.5±0.1g/kg body wt/d) and by UUN mean protein intake was 52.0±11.01g/d (0.64±0.05g/kg body wt/d); a decrease in habitual protein intake of 49% and 25% respectively as estimated from FR and UUN. Subjects underreported their food intake when total calories calculated from food records were compared to total energy expenditure from indirect calorimetry using a physical activity factor of 1.2. Degree of underreporting was most apparent in the subject with the lowest instrumental activities of daily living score. Subjects newly prescribed a low protein diet were able to reach the goal of 0.6 g protein/kg utilizing these techniques. Although a low protein diet may be desirable in early stage CRI, clinicians may experience difficulty with adherence due to lack of counseling time and frequent monitoring.