Caroline C. Horwath

Faster Self-Reported Speed of Eating Is Related to Higher Body Mass Index in a Nationwide Survey of Middle-Aged Women

This study is the first nationwide population survey to explore the association between speed of eating and degree of obesity. The objective was to cross-sectionally examine the relationship between self-reported speed of eating and body mass index (BMI; calculated as kg/m(2)) in a nationally representative sample of New Zealand women. In May 2009, a sample of 2,500 New Zealand women aged 40 to 50 years was randomly selected from the nationwide electoral rolls. A 66% participation rate was achieved. Potential participants were mailed a self-administered questionnaire containing questions on self-reported speed of eating, demographics, health conditions, menopause status, physical activity, height, and weight. Univariate models were used to examine the associations between demographic, health and behavioral variables, and BMI, while a multivariate model was developed to investigate the relationship between self-reported speed of eating and BMI. After adjusting for age, smoking status, menopause status, thyroid condition, ethnicity, socioeconomic status, and physical activity, BMI statistically significantly increased by 2.8% (95% confidence interval: 1.5% to 4.1%; P<0.001) for each category increase in self-reported speed of eating. Although the direction of causality requires confirmation in longitudinal and randomized intervention studies, the results suggest that faster eating is associated with higher BMI in middle-aged women.

Many apples a day keep the blues away--daily experiences of negative and positive affect and food consumption in young adults.

OBJECTIVES Prior research has focused on the association between negative affect and eating behaviour, often utilizing laboratory or cross-sectional study designs. These studies have inherent limitations, and the association between positive affect and eating behaviour remains relatively unexplored. Therefore, the objective of this study was to investigate the bidirectional relationships between daily negative and positive affective experiences and food consumption in a naturalistic setting among healthy young adults. DESIGN Daily diary study across 21 days (microlongitudinal, correlational design). METHODS A total of 281 young adults with a mean age of 19.9 (± 1.2) years completed an Internet-based daily diary for 21 consecutive days. Each day they reported their negative and positive affect, and their consumption of five specific foods. Hierarchical linear modelling was used to test same-day associations between daily affect and food consumption, and next-day (lagged) associations to determine directionality. Moderating effects of BMI and gender were also examined in exploratory analyses. RESULTS Analyses of same-day within-person associations revealed that on days when young adults experienced greater positive affect, they reported eating more servings of fruit (p = .002) and vegetables (p < .001). Results of lagged analysis showed that fruits and vegetables predicted improvements in positive affect the next day, suggesting that healthy foods were driving affective experiences and not vice versa. Meaningful changes in positive affect were observed with the daily consumption of approximately 7-8 servings of fruit or vegetables. CONCLUSIONS Eating fruit and vegetables may promote emotional well-being among healthy young adults.

Evaluation of a “Nondieting” Stress Reduction Program for Overweight Women: A Randomized Trial:

Purpose. Determine if a “nondieting” intervention focused on intensive training in eliciting the relaxation response enhances health outcomes compared with nondieting interventions without such training. Design. Randomized trial with follow-up at 10 weeks, 4 months, and 12 months. Setting. General community. Subjects. Total of 225 overweight and obese women with at least one other cardiovascular risk factor. Interventions. Three 10-week nondieting interventions: a group program (P1) focused on intensive training in techniques for eliciting the relaxation response (n = 60), a group program (P2) focused on healthy eating and physical activity (n = 61), and a self-guided, mail-delivered version of P2 (P3; n = 101). Measures. The Revised Symptom Checklist measured psychological distress, the Medical Symptoms Checklist measured the experience of medical symptoms, and the Health-Promoting Lifestyle Profile measured a range of lifestyle behaviors. Self-efficacy for low-fat eating, intuitive eating, and body mass index were also assessed. Analysis. An intention-to-treat analysis was used. Results. At 12 months, P1 produced statistically greater improvements in stress management behaviors and medical symptom discomfort and was the only program to significantly improve self-efficacy for low-fat eating. In P1, the effect sizes for reductions in depression (0.75) and interpersonal sensitivity (0.85) were large. At 12 months, mean weight was unchanged. Conclusion. Inclusion of intensive relaxation response training in a nondieting program for overweight women enhanced stress management and medical symptoms outcomes but not weight outcomes.

Perceived benefits and barriers of increased fruit and vegetable consumption: validation of a decisional balance scale.

OBJECTIVE To develop and validate scales to assess perceived benefits and barriers (decisional balance) for increasing fruit and vegetable consumption. DESIGN A cross-sectional mail and telephone survey was conducted. SUBJECTS/SETTINGS A total of 1200 Chinese households were randomly selected from the Singapore residential telephone listings, and 71% responded to the mail survey; 390 males and 406 females participated (mean age = 39.3). MAIN OUTCOME MEASURES Decisional balance, stage of change, and fruit and vegetable consumption were measured. STATISTICAL ANALYSES PERFORMED Using a split-half sample approach, developmental sample responses were analyzed by principal-components analysis and validation sample responses by confirmatory factor analysis. Analyses of variance were used to examine stage differences in decisional balance. RESULTS Principal-components analysis indicated two components representing benefits (or pros) (Cronbachs alpha = 0.86) and barriers (or cons) (alpha 0.79) of change. Confirmatory factor analysis strongly supported the two-component structure (Goodness of Fit Index = 0.97). There was a shift from cons to pros being more important across the stages. The increase in pros across the stages of change (p < 0.0001) corresponded to a medium effect size, and the decrease in cons (p < 0.01) corresponded to a small effect size. IMPLICATIONS Decisional balance scales may be used to guide interventions to influence fruit and vegetable consumption.

Validation of a short food frequency questionnaire to assess consumption of cereal foods, fruit and vegetables in Chinese Singaporeans

Objective: To assess the ability of a 16-item food frequency questionnaire (FFQ) to measure consumption of cereal foods, fruit and vegetables in Chinese Singaporeans.Design: Subjects completed the questionnaire twice, at the beginning and end of a six-week period during which they also provided three 24 h diet recalls. Estimates of intake from the questionnaire were compared with those from diet recalls.Subjects: Subjects were recruited from a range of occupational groups through random sampling across divisions in the headquarters of the Singapore Ministry of Health. Of the 81 subjects initially recruited, three failed to complete the diet recalls, one was excluded due to changes in diet, and seven did not return the second questionnaire.Results: Mean difference in food group consumption estimated by the two methods did not differ significantly from zero for fruit (0.00 serving, s.d.=0.54, 95% CI=−0.13, +0.12, P=0.95) or vegetables (−0.05, s.d.=0.29, 95% CI=−0.12, +0.02, P=0.13). For cereal foods, the mean difference was small, but significantly different from zero only in women (−0.32 servings, s.d.=0.92, 95% CI=−0.59, −0.06, P=0.02). At an individual level, cereal food intake as measured by the FFQ may be 37% below or 59% above the diet recall values; and values for total fruit and vegetables may be half or double the recall values. Among subjects whose intake was classified into the lowest quartiles by diet recalls, 78% and 94% respectively, fell into the lowest two questionnaire quartiles for cereal foods, and total fruit and vegetables. The ability of the questionnaire to predict those having inadequate intake based on recall data was more than 90% for the three food groups.Conclusion: The short questionnaire cannot replace the three-day recalls in intake assessment for individuals, but it could be used to screen for low consumers in intervention programmes, to assess mean food group intake in population groups, and to rank individuals into broad categories of food group intake.Sponsorship: International Life Sciences Institute, South East Asia.

Defining and Measuring Stages of Change for Dietary Behaviors: Readiness to Meet Fruit, Vegetable, and Grain Guidelines among Chinese Singaporeans

OBJECTIVE To assess the ability of 2 algorithms to classify people by stage of change for consuming the recommended servings of grains (cereal foods) and total fruit and vegetables. DESIGN Assessment of stage involved an objective behavioral measure in the form of a self-administered food frequency questionnaire, followed by a brief telephone interview to assess intentions of subjects to increase intake to meet the recommended servings. Validity of the stage classification was assessed by comparison with three 24-hour dietary recalls. SUBJECTS One hundred and one Singaporean Chinese subjects (mean age = 38.7; 51% men) were recruited from 716 respondents who had taken part in a survey investigating factors influencing consumption of grains, fruit, and vegetables. STATISTICAL ANALYSES PERFORMED Differences in mean intake by diet recalls across the stages were investigated using analysis of variance. Sensitivity, specificity, and predictive values of the algorithms were also determined. RESULTS There were significant increases across the stages in mean intake of grains (men: F(2,48) = 20.30, P < .001; women: F(2,47) = 23.39, P < .0001), and total fruit and vegetables (men: F(2,48) = 30.29, P < .005; women: F(2,47) = 37.29, P < .0001). Based on diet recalls for grains intake, the algorithms classified 89% of subjects having inadequate intakes into the preaction stages, and 75% of those having adequate intakes into the action or maintenance stages. For fruit and vegetables, 93% of subjects having inadequate intakes were classified into the preaction stages, and 76% of those having adequate intakes were classified into the action or maintenance stages. CONCLUSION Algorithms developed to assess stages of change for food-based rather than nutrient goals, and which include an objective assessment of intake, appear to improve the accuracy of stage classifications.

Factors influencing milk and milk product consumption in young and elderly women with low calcium intakes

Abstract The aim of this research was to investigate factors influencing milk and milk product consumption in young and elderly women consuming less than two-thirds of the RDA for calcium. Semi-structured, open-ended interviews were conducted with 71 women over 70 years and 22 women aged 19–23 years. Questions addressed changes in milk and milk product intake, and reasons for changes; perceptions of the likely effects of an increased intake of milk or milk products on health; reasons for low consumption of milk or milk products; and willingness to increase intake of various calcium-rich foods. The elderly low-calcium consumers were identified from a nutrition and health study of all people over 70 years residing in one New Zealand town. The young women were low-calcium consumers identified from a university class of nutrition students. Older women were most likely to perceive that increasing their milk or milk product intake would have either no effect on their health or adverse effects on conditions such as diabetes, high blood cholesterol or blood pressure, and heart problems. Although young women were more likely to perceive potential health benefits from consuming more milk (and to a lesser extent milk products), an increase in body weight was the reason given by all those who believed an increased intake would be bad for them. Some 13–18% of women had been advised by doctors to eliminate milk or milk products from their diet, usually for inappropriate reasons. For both age groups, dislike was the most important reason for not consuming more milk; however health concerns were the primary reason for not consuming more of the other dairy products. There is need to actively counter misconceptions amongst both women (particularly elderly women) and doctors, concerning adverse effects of milk or milk products on health conditions. For young women, emphasis is needed that weight control does not require the exclusion of milk or milk products from the diet. Programs are required to increase awareness of the wide range of low-fat milks and milk products now available, and of the potential benefits of these for bone health.

DIETARY SURVEY OF A LARGE RANDOM SAMPLE OF ELDERLY PEOPLE: ENERGY AND NUTRIENT INTAKES

Abstract The average daily intakes of energy and nutrients were estimated in a randomlyselected group of 2195 people aged 65 years and over residing in Adelaide, South Australia, by means of a semi-quantitative food frequency questionnaire. Mean intakes for most nutrients were equal to or above the recommended intakes. The proportion of people with intakes below two-thirds of the RDA, however, was highest for folate, calcium, magnesium, copper, and zinc, and varied from approximately 10 to 35 per cent of the total group. Comparisons with the results of other large surveys of noninstitutionalized elderly people in Boston and Gothenburg, Sweden, showed some variation in total intakes, but many similarities in patterns of nutrient density and those nutrients least adequately supplied.

DIETARY INTAKE AND NUTRITIONAL STATUS AMONG UNIVERSITY UNDERGRADUATES

Abstract Three 3-day diet records were used to estimate usual nutrient intake in a group of 122 undergraduate nutrition students in Dunedin, New Zealand. Information concerning dietary supplement use and dieting patterns was obtained, and measurements made of serum ferritin, plasma total cholesterol, plasma ascorbic acid and total plasma corotenoids. For men (n=29), mean intakes for most nutrients were above the recommended levels, and the proportion with intakes below twothirds of the RDA was also minimal for most nutrients. Among women (n=93), mean intakes of vitamin B6, calcium, iron, magnesium, zinc and copper fell below the 1989 US levels, and the prevalence of intakes below two thirds of the US recommendation was at least one third for calcium, iron, vitamin B6, zinc and copper, and 16% for vitamin B12. Ten per cent of women but no men had low serum ferritin levels, and 35 per cent of women and 14 per cent of men had total plasma cholesterol levels above 5.5 mmol/l. Dietary supplements were regularly taken at least once a week by 7 per cent of men and 16 per cent of women.

Investigating Fruit and Vegetable Consumption Using the Transtheoretical Model

Purpose. Test the applicability of the transtheoretical model (TTM) to adult fruit/vegetable consumption. Design. Cross-sectional random-digit dial survey. Setting. Hawaii. Subjects. 700 (62.6% female; age [mean ± SD], 47 ± 17.1 years; education [mean ± SD], 14.6 ± 2.8 years; 35.0% white, 31.1% Asian, 22.1% native Hawaiian/Pacific Islander, 11.8% other). Measures. Stages, processes, self-efficacy, decisional balance, and self-reported fruit/vegetable consumption. Analysis. Confirmatory factor analysis tested the factor structure. Analyses of variance were used to explore stage differences in constructs. Results. Stage distribution was precontemplation (33%), contemplation (4%), preparation (37%), action (3%), and maintenance (23%). A 10-factor process model with two higher-order correlated factors (experiential and behavioral) provided the best data fit (X2 = 1446.12; df = 366; p < .0001; comparative fit index [CFI] = .89; standardized root mean square residual [SRMR] = .05). The self-efficacy structure fit the data well (X2 = 81.86; df = 9; p < .0001; CFI = .94; SRMR = .04), as did the decisional balance structure (X2 = 37.42; df = 19;p = .007; CFI = .99; SRMR = .02). Processes, self-efficacy, decisional balance, and fruit/vegetable consumption behavior differed significantly by stage, with medium effect sizes for most variables. Conclusion. The variables revealed adequate fit to the theorized measurement models. TTM predictions regarding stage differences in self-efficacy, pros and cons, and fruit/vegetable consumption were confirmed; however, most experiential and behavioral processes increased in the early stages and then leveled off.