Ellen Smit

Race/ethnicity, social class and their relation to physical inactivity during leisure time: results from the Third National Health and Nutrition Examination Survey, 1988–1994

BACKGROUND Physical inactivity is more prevalent among racial and ethnic minorities than among Caucasians. It is not known if differences in participation in leisure time physical activity are due to differences in social class. Thus, this paper provides estimates of the prevalence of physical inactivity during leisure time and its relationship to race/ethnicity and social class. METHODS This was a national representative cross-sectional survey with an in-person interview and medical examination. Between 1988 and 1994, 18,885 adults aged 20 or older responded to the household adult and family questionnaires as part of the Third National Health and Nutrition Examination Survey . Mexican-Americans and African-Americans were over-sampled to produce reliable estimates for these groups. Multiple assessment of social class included education, family income, occupation, poverty status, employment status, and marital status. RESULTS The age-adjusted prevalence (per 100) of adults reporting leisure time inactivity is lower among Caucasians (18%) than among African-Americans (35%) and Mexican-Americans (40%). African-American and Mexican-American men and women reported higher prevalence of leisure time inactivity than their Caucasian counterparts across almost every variable, including education, family income, occupation, employment, poverty and marital status. CONCLUSIONS Current indicators of social class do not seem to explain the higher prevalence of physical inactivity during leisure time among African-American and Mexican-American. More research is needed to examine the effect of other constructs of social class such as acculturation, safety, social support and environmental barriers in promoting successful interventions to increase physical activity in these populations.

Use of Recovery Biomarkers to Calibrate Nutrient Consumption Self-Reports in the Women's Health Initiative

Underreporting of energy consumption by self-report is well-recognized, but previous studies using recovery biomarkers have not been sufficiently large to establish whether participant characteristics predict misreporting. In 2004-2005, 544 participants in the Womens Health Initiative Dietary Modification Trial completed a doubly labeled water protocol (energy biomarker), 24-hour urine collection (protein biomarker), and self-reports of diet (assessed by food frequency questionnaire (FFQ)), exercise, and lifestyle habits; 111 women repeated all procedures after 6 months. Using linear regression, the authors estimated associations of participant characteristics with misreporting, defined as the extent to which the log ratio (self-reported FFQ/nutritional biomarker) was less than zero. Intervention women in the trial underreported energy intake by 32% (vs. 27% in the comparison arm) and protein intake by 15% (vs. 10%). Younger women had more underreporting of energy (p = 0.02) and protein (p = 0.001), while increasing body mass index predicted increased underreporting of energy and overreporting of percentage of energy derived from protein (p = 0.001 and p = 0.004, respectively). Blacks and Hispanics underreported more than did Caucasians. Correlations of initial measures with repeat measures (n = 111) were 0.72, 0.70, 0.46, and 0.64 for biomarker energy, FFQ energy, biomarker protein, and FFQ protein, respectively. Recovery biomarker data were used in regression equations to calibrate self-reports; the potential application of these equations to disease risk modeling is presented. The authors confirm the existence of systematic bias in dietary self-reports and provide methods of correcting for measurement error.

Association between markers of the metabolic syndrome and lower urinary tract symptoms in the Third National Health and Nutrition Examination Survey (NHANES III).

OBJECTIVE:To examine the association of components of the metabolic syndrome with lower urinary tract symptoms (LUTS), which often result from prostate enlargement and heightened tone of prostate and bladder smooth muscle.DESIGN:Third National Health and Examination Survey (NHANES III), from which LUTS cases and controls were selected.SUBJECTS:A total of 2372 men aged 60+ y who participated in NHANES III. LUTS cases were men with at least three of these four symptoms: nocturia, incomplete bladder emptying, weak stream, and hesitancy, and who never had noncancer prostate surgery. Controls were men without any of the symptoms and who never had noncancer prostate surgery.MEASUREMENTS:As part of NHANES III, an oral glucose tolerance test was carried out, glycosylated hemoglobin, HDL and LDL cholesterol, and triglycerides were measured, and history of diabetes mellitus and hypertension were assessed. Logistic regression was used to calculate odds ratios (ORs) after applying sampling weights.RESULTS:History of diabetes (OR 1.67; 95% confidence interval (CI) 0.72–3.86) and hypertension (OR 1.76; 95% CI 1.20–2.59) appeared to be positively associated with LUTS. The odds of LUTS increased with increasing glycosylated hemoglobin (P-trend=0.005). No statistically significant associations between fasting or 2-h glucose or fasting insulin and LUTS were observed. However, men classified as having three or more components of the metabolic syndrome had an increased odds of LUTS (OR=1.80; 95% CI 1.11–2.94).CONCLUSION:These findings support the role for metabolic perturbations in the etiology of LUTS.

Estimates of Animal and Plant Protein Intake in US Adults: Results from the Third National Health and Nutrition Examination Survey, 1988–1991

OBJECTIVE To describe the sources of protein intake in a sample of the US adult population and among subgroups defined by race-ethnicity, age, and gender. DESIGN The Third National Health and Nutrition Examination Survey, 1988-1991, is a stratified random sample of the total civilian noninstitutionalized population, drawn from the 50 United States and the District of Columbia. For all foods consumed by the participants, based on a 24-hour dietary recall, protein sources and the contribution of each protein type to the total protein intake were determined. SUBJECTS Adult participants in the third National Health and Nutrition Examination Survey (n = 7,924). STATISTICAL ANALYSES Weighted total, age-specific, and age-adjusted mean protein intakes were calculated using SAS and WesVarPC. Statistical differences were determined by 2-tailed t tests. RESULTS The main protein source in the American diet is animal protein (69%). Meat, fish, and poultry protein combined contributed the most to animal protein (42%), followed by dairy protein (20%). Grains (18%) contributed the most to plant protein consumption. Women consumed a lower percentage of beef (14%) and pork (7%) protein than did men (18% and 9%, respectively). Women also consumed a higher percentage of poultry (13%), dairy (22%), and fruit and vegetable (11%) protein than did men (11%, 19%, and 9%, respectively). Blacks reported eating a higher percentage of poultry (18%) and pork (11%) protein and a lower percent of dairy protein (14%) than did whites (12%, 7%, and 22%, respectively) and Mexican-Americans (11%, 8%, and 17%, respectively). Mexican-Americans consumed a higher percentage of legume (7%) and egg (7%) protein than did whites (4% and 4%, respectively) and blacks (4% and 5%, respectively). Whites consumed a higher percentage of grain protein (19%) than did blacks (16%) and Mexican-Americans (15%). CONCLUSIONS These results show that, although the percentage of total energy from protein may be similar among race-ethnicities and between men and women, their sources of protein are different. These differences should be taken into account when providing nutrition education for specific populations.

Prevalence of and racial/ethnic variation in lower urinary tract symptoms and noncancer prostate surgery in U.S. men ☆

OBJECTIVES To estimate the proportion of U.S. men affected by specific lower urinary tract symptoms (LUTS) and to assess whether the prevalence of LUTS varies by race/ethnicity. METHODS Included were 30+-year-old men who took part in the Third National Health and Nutrition Examination Survey. Men were asked whether they experienced nocturia, incomplete emptying, or hesitancy. Men 60+ years old were also asked whether they had a decreased urinary stream or had ever undergone noncancer prostate surgery. To obtain the estimated prevalences for the U.S. population, we applied sampling fraction weights. We calculated age-adjusted odds ratios (ORs) of 3+ symptoms or surgery by race/ethnicity using logistic regression analysis. RESULTS Only nocturia was common in 30 to 59-year-old men. Among men who had not had prostate surgery, 59.9% of men 60 to 69 years old and 75.1% of men 70+ years old had at least one symptom. All four symptoms were reported by 3.0% of men 60 to 69 years and 5.6% of men 70+ years old. Of the men 60 to 69 years old and men 70+ years old, 8.0% and 22.4%, respectively, reported having undergone surgery. In men 60+ years old, the age-adjusted OR for either having 3+ symptoms or surgery was 0.8 for non-Hispanic black men compared with non-Hispanic white men. The odds of having 3+ symptoms (OR = 1.6), but not surgery (OR = 1.1), appeared greater for Mexican-American men than for non-Hispanic white men. CONCLUSIONS Specific LUTS are common in older U.S. men. Older black men were not more likely to have LUTS than were older white men. The apparent modestly higher prevalence of LUTS in older Mexican-American men requires additional study.

The relationship of physical activity and body weight with all-cause mortality: results from the Puerto Rico Heart Health Program.

PURPOSE To study the relationship of physical activity and obesity with all-cause mortality in Puerto Rican Men. METHODS The Puerto Rico Heart Health Program collected physical activity and anthropometric measurements in 9,824 men between 1962 and 1965. After excluding those with known coronary heart disease at baseline, and those who died within the first three years of the study we analyzed the data for the relationship between physical activity and overweight status to all-cause mortality in 9,136 men. We stratified our participants by quartiles of physical activity. Participants were classified into four categories of body weight: underweight (BMI < 18.5), healthy weight (BMI =18.5-24.9), overweight (BMI = 25-29.9), and obese (BMI = 30+). RESULTS After adjusting for age, education, smoking status, hypertension status, hypercholesterolemic status, urban/rural residence, and overweight status, physical activity was independently related to all-cause mortality. All-cause mortality was lower in those in quartile 2 (OR = 0.68, CI = 0.58-0.79) than quartile 1 (reference, sedentary group). Mortality among those in quartile 3 and 4 (0.63, CI = 0.54-0.75; and 0.55, CI = 0.46-0.65, respectively) were also significantly lower than those observed in quartile 1, but not significantly lower than those observed in quartile 2. Furthermore, within every category of body weight, those who were most active had significantly lower odds ratio of all-cause mortality. CONCLUSION Our findings support the current recommendation that some physical activity is better than none, in protecting against all-cause mortality. The benefits of an active lifestyle are independent of body weight and that overweight and obese Puerto Rican men who are physically active experienced significant reductions in all-cause mortality compared with their sedentary counterparts.

Dairy Products and Ovarian Cancer: A Pooled Analysis of 12 Cohort Studies

Background: Dairy foods and their constituents (lactose and calcium) have been hypothesized to promote ovarian carcinogenesis. Although case-control studies have reported conflicting results for dairy foods and lactose, several cohort studies have shown positive associations between skim milk, lactose, and ovarian cancer. Methods: A pooled analysis of the primary data from 12 prospective cohort studies was conducted. The study population consisted of 553,217 women among whom 2,132 epithelial ovarian cases were identified. Study-specific relative risks and 95% confidence intervals were calculated by Cox proportional hazards models and then pooled by a random-effects model. Results: No statistically significant associations were observed between intakes of milk, cheese, yogurt, ice cream, and dietary and total calcium intake and risk of ovarian cancer. Higher lactose intakes comparing ≥30 versus <10 g/d were associated with a statistically significant higher risk of ovarian cancer, although the trend was not statistically significant (pooled multivariate relative risk, 1.19; 95% confidence interval, 1.01-1.40; Ptrend = 0.19). Associations for endometrioid, mucinous, and serous ovarian cancer were similar to the overall findings. Discussion: Overall, no associations were observed for intakes of specific dairy foods or calcium and ovarian cancer risk. A modest elevation in the risk of ovarian cancer was seen for lactose intake at the level that was equivalent to three or more servings of milk per day. Because a new dietary guideline recommends two to three servings of dairy products per day, the relation between dairy product consumption and ovarian cancer risk at these consumption levels deserves further examination. (Cancer Epidemiol Biomarkers Prev 2006;15(2):364–72)

Association of cigarette smoking, alcohol consumption and physical activity with lower urinary tract symptoms in older American men: findings from the third National Health And Nutrition Examination Survey

To examine the association of cigarette smoking, alcohol consumption and physical activity with lower urinary tract symptoms (LUTS) in older men.

Dietary intake of community-based HIV-1 seropositive and seronegative injecting drug users

Dietary intake was assessed in a subsample of a cohort of inner-city injecting drug users (IDUs). In this population of predominantly African-American IDUs, including both HIV -1-infected and noninfected men and women, a food frequency questionnaire (FFQ) and a 24-h recall were administered. One hundred seven volunteers participated. Although total caloric intake was consistently higher with the food frequency method, percent of total calories from fat, protein, and carbohydrates were similar between the FFQ and 24-h recall. Spearmans correlations for agreement between the 24-h recall and the FFQ ranged from 0.22 for vitamin E to 0.52 for carbohydrates. HIV-1 seropositives reported higher protein (p = 0.05) and fat (p = 0.02) consumption than seronegatives according to the 24-h recall. The difference in total fat consumption was due to higher intakes of saturated and monounsaturated fats (p = 0.01). Median intakes of vitamins B2 and B12, pantothenic acid (p < or = 0.05), phosphorous (p < or = 0.01), and selenium (p < or = 0.005) were also greater in HIV-1 seropositives. Reported intake of vitamins A and E, calcium, and zinc were below the recommended daily allowances for both HIV-1 seropositives and seronegatives. Although intakes of most nutrients appeared adequate for the group as a whole, extreme ranges were observed and may be the result of imbalanced food selections and day to day variation. Food group analysis indicated low intakes of fruits, vegetables, milk, and milk products. More research is needed to fully understand the implication of dietary habits and nutritional status in the free-living HIV-1-infected and noninfected IDUs.

Fruits and Vegetables and Ovarian Cancer Risk in a Pooled Analysis of 12 Cohort Studies

Because fruits and vegetables are rich in bioactive compounds with potential cancer-preventive actions, increased consumption may reduce the risk of ovarian cancer. Evidence on the association between fruit and vegetable intake and ovarian cancer risk has not been consistent. We analyzed and pooled the primary data from 12 prospective studies in North America and Europe. Fruit and vegetable intake was measured at baseline in each study using a validated food-frequency questionnaire. To summarize the association between fruit and vegetable intake and ovarian cancer, study-specific relative risks (RR) were estimated using the Cox proportional hazards model, and then combined using a random-effects model. Among 560,441 women, 2,130 cases of invasive epithelial ovarian cancer occurred during a maximum follow-up of 7 to 22 years across studies. Total fruit intake was not associated with ovarian cancer risk—the pooled multivariate RR for the highest versus the lowest quartile of intake was 1.06 [95% confidence interval (95% CI), 0.92-1.21; P value, test for trend = 0.73; P value, test for between-studies heterogeneity = 0.74]. Similarly, results for total vegetable intake indicated no significant association (pooled multivariate RR, 0.90; 95% CI, 0.78-1.04, for the highest versus the lowest quartile; P value, test for trend = 0.06; P value, test for between-studies heterogeneity = 0.31). Intakes of botanically defined fruit and vegetable groups and individual fruits and vegetables were also not associated with ovarian cancer risk. Associations for total fruits and vegetables were similar for different histologic types. These results suggest that fruit and vegetable consumption in adulthood has no important association with the risk of ovarian cancer.