Fatma G. Huffman

Parenthood—A Contributing Factor to Childhood Obesity

Prevalence of childhood obesity and its complications have increased world-wide. Parental status may be associated with children’s health outcomes including their eating habits, body weight and blood cholesterol. The National Health and Nutrition Examination Survey (NHANES) for the years 1988–1994, provided a unique opportunity for matching parents to children enabling analyses of joint demographics, racial differences and health indicators. Specifically, the NHANES III data, 1988–1994, of 219 households with single-parents and 780 dual-parent households were analyzed as predictors for primary outcome variables of children’s Body Mass Index (BMI), dietary nutrient intakes and blood cholesterol. Children of single-parent households were significantly (p < 0.01) more overweight than children of dual-parent households. Total calorie and saturated fatty acid intakes were higher among children of single-parent households than dual-parent households (p < 0.05). On average, Black children were more overweight (p < 0.04) than children of other races. The study results implied a strong relationship between single-parent status and excess weight in children. Further studies are needed to explore the dynamics of single-parent households and its influence on childhood diet and obesity. Parental involvement in the development of school- and community-based obesity prevention programs are suggested for effective health initiatives. Economic constraints and cultural preferences may be communicated directly by family involvement in these much needed public health programs.

Functional Foods from Cereal Grains

Cereal grains and germs are good sources of various phytochemicals. The major phytochemicals present in cereal grains are: phenolic acids, flavones, phytic acid, flavanoids, coumarins, and terpenes. Cereal germs are good sources of ferulic acid, phytic acid, glutathione, and phytosterols. In addition, the cereal germ acontains the vitamins E, B1, B2, and B3, the minerals P, K, Mg, Ca, Zn, and S, and fiber. Because of its rich nutrient content, cereal germ would be a valuable ingredient for production of functional foods. Our article examines the feasibility of using constituents of selected cereal grains such as wheat, oat, psyllium, and barley in producing functional foods.

Validation of a semiquantitative food frequency questionnaire to assess energy and macronutrient intakes of Cuban Americans

Objective To assess the validity of a 131-item semiquantative food frequency questionnaire (FFQ) by comparison with multiple food records in Cuban Americans. Design The Willet FFQ was administered and food consumptions of three random days (two weekdays and one weekend day) were collected. Setting Cuban Americans residing in Miami. Participants Twenty adult Cuban American volunteers who participated in a larger epidemiological study to evaluate the dietary risk of type 2 diabetes and cardiovascular disease. Results There were no significant differences in the mean intakes of energy, macronutrients, cholesterol and alcohol estimated by the Willett FFQ and the 3-day food records. For most of the macronutrients the correlation coefficients ranged from 0.14 to 0.71. The correlation coefficient was highest for polyunsaturated fatty acid (r = 0.71, P<0.001) and lowest for protein (r = 0.14, P=0.56). Correlation coefficients for carbohydrate (r = 0.42) and monounsaturated fatty acid (r = 0.43) were only marginally significant (P=0.06). Conclusions Compared with 3-day food records, the Willett FFQ is a reasonable instrument to assess the intakes of most macronutrients and alcohol among Cuban Americans. Further studies should be conducted to validate the usefulness of the Willett FFQ in Cuban Americans for other nutrients.

Randomized Controlled Trial to Determine the Effectiveness of an Interactive Multimedia Food Safety Education Program for Clients of the Special Supplemental Nutrition Program for Women, Infants, and Children

BACKGROUND Pregnant women and the very young are among those most susceptible to foodborne infections and at high risk of a severe outcome from foodborne infections. OBJECTIVE To determine if interactive multimedia is a more effective method than pamphlets for delivering food safety education to Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clients. DESIGN A randomized controlled trial of WIC clients was conducted. Self-reported food safety practices were compared between pre- and postintervention questionnaires completed >or=2 months after the intervention. SUBJECTS/SETTING Pregnant WIC clients or female caregivers (usually mothers) of WIC clients who were 18 years of age or older and able to speak and read English were recruited from an inner-city WIC clinic. INTERVENTION Participants were randomized to receive food safety pamphlets or complete an interactive multimedia food safety education program on a computer kiosk. MAIN OUTCOME MEASURES Change from pre- to postintervention food safety scores. STATISTICAL ANALYSES PERFORMED A mean food safety score was determined for each participant for the pre- and postintervention questionnaires. The scores were used in a two-group repeated measures analysis of variance. RESULTS Of the 394 participants, 255 (64.7%) completed the postintervention questionnaire. Satisfaction with the program was high especially among those with no education beyond high school. When considering a repeated measures analysis of variance model with the two fixed between-subject effects of group and age, a larger improvement in score in the interactive multimedia group than in the pamphlet group (P=0.005) was found, but the size of the group effect was small (partial eta(2)=0.033). Women aged 35 years or older in the interactive multimedia group had the largest increase in score. CONCLUSIONS The interactive multimedia was well-accepted and resulted in improved self-reported food safety practices, suggesting that interactive multimedia is an effective option for food safety education in WIC clinics.

Assessing Overweight and Cardiovascular Risks among College Students.

Abstract Although studies regarding health issues and the obesity epidemic have increased in recent years, few of these studies target college-aged students. The primary purpose of this study was to evaluate the differences in race/ethnicity with respect to prevalence of overweight/obesity (defined by body mass index or BMI) among college students attending an urban university. In addition, the demographic characteristics and cardiovascular risks between the overweight and obese group (n=138) were compared to the underweight and normal weight group (n=349). The study included 487 college students under 40 years of age who identified their origin as white (non-Hispanic), black (non-Hispanic), or Hispanic. There were 32.65% white, 33.26% Hispanic, and 34.09% black. The mean and median ages were 21 and 19 years, respectively. The overall prevalence of overweight/obesity was 28.11%, with 23.91% (white), 34.06% (Hispanic), and 42.03% (black). Age-, gender-, and race-/ethnicity-adjusted cardiovascular risk levels (blood pressure, pulse pressure, blood glucose and lipid profiles) significantly varied between two groups. The findings suggest that screening cardiovascular risks among a college-aged population is warranted. Our study further indicates the need for weight management and risk reduction of overweight-related chronic diseases on campus.

Waist Circumference and BMI in Relation to Serum High Sensitivity C-Reactive Protein (hs-CRP) in Cuban Americans With and Without Type 2 Diabetes

Relationship between high-sensitivity C-reactive protein (hs-CRP) and adiposity by diabetes status and gender in Cuban-Americans with and without type 2 diabetes (T2D) was studied. Adult subjects, 226 females, 129 males participated in a case control, single time point study. Subjects with T2D were older, had higher waist circumference (WC) and body mass index (BMI). WC and BMI were associated with ln hs-CRP (P < 0.001). An interaction with diabetes status was found for BMI (P = 0.037). Gender showed a strong relationship with ln hs-CRP (P < 0.001), which was moderated by diabetes status. Only males without diabetes exhibited a significant relationship for both WC and BMI with ln hs-CRP. In this sample of Cuban-Americans, WC and BMI had stronger associations with ln hs-CRP but not with diabetes status. Obesity prevention and controlling for CRP levels may be necessary to eliminate its contributions to develop diabetes and cardiovascular disease (CVD).

Television Watching, Diet Quality, and Physical Activity and Diabetes among Three Ethnicities in the United States

Diabetes is a world-wide epidemic associated with multiple environmental factors. Prolonged television viewing (TV) time has been related to increased risk of obesity and type 2 diabetes in several studies. TV viewing has been positively associated with cardiovascular disease risk factors, lower energy expenditure, over-eating high-calorie and high-fat foods. The objective of this study was to assess the associations of hours of TV viewing with dietary quality, obesity and physical activity for three ethnic minorities with and without type 2 diabetes. Diet quality and physical activity were inversely related to prolonged TV viewing. African Americans and participants with type 2 diabetes were more likely to watch more than 4 hours of TV per day as compared to their counterparts. Diet quality was inversely associated with physical activity level. Future studies are needed to establish the risk factors of prolonged TV watching in adult populations for the development of diabetes or diabetes-related complications. Although strategies to reduce TV watching have been proven effective among children, few trials have been conducted in adults. Intervention trials aimed at reducing TV viewing targeting people with type 2 diabetes may be beneficial to improve dietary quality and physical activity, which may reduce diabetes complications.

The Healthy Eating Index and the Alternate Healthy Eating Index as predictors of 10-year CHD risk in Cuban Americans with and without type 2 diabetes.

OBJECTIVE To examine the relationship between dietary patterns, as measured by the Healthy Eating Index (HEI) and the Alternate Healthy Eating Index (AHEI), and 10-year predicted CHD risk in Cuban Americans with and without type 2 diabetes (T2D). DESIGN In a cross-sectional study participants were selected from two randomly generated mailing lists of individuals with and without T2D. HEI and AHEI scores were calculated from a self-reported FFQ. CHD risk was determined using the 10-year CHD risk calculator of the Adult Treatment Panel III. SETTING Miami Dade and Broward Counties, FL, USA. SUBJECTS Cuban Americans (n 358) aged ≥30 years. RESULTS Participants with T2D had a higher waist circumference (P = 0·001) and 10-year CHD risk score (P = 0·008) compared with those without T2D. Participants without T2D had a higher energy intake (P = 0·034), total blood cholesterol (P = 0·007), HDL cholesterol (P = 0·001) and HEI score (P = 0·006) compared with participants with T2D. AHEI score was a significant predictor of 10-year CHD risk (F(1,351) = 4·44, P = 0·036). An association between AHEI and 10-year CHD risk was found only for participants with T2D (β = -0·244, se = 0·049, P = 0·001).ConclusionThe present study showed that only participants with T2D with significantly higher AHEI scores had lower scores for 10-year predicted CHD risk. No association was found between HEI score and CHD risk among Cuban Americans. Individuals with T2D are advised to follow the AHEI dietary pattern.

Validation of serum transthyretin (prealbumin) as a nutritional parameter in hemodialysis patients.

OBJECTIVE To evaluate the use of serum transthyretin (TTR) as a valid indicator of nutritional status in the hemodialysis patient and to validate the correlation of low-serum (TTR) levels with established nutrition assessment parameters. DESIGN Prospective, cohort, correlation analysis. SETTING Free-standing outpatient dialysis center. PATIENTS Fifty-one stable, chronic hemodialysis patients meeting the following selection criteria: (1) received thrice weekly hemodialysis treatments for greater than 3 months, (2) absence of impaired hepatic function, (3) absence of chronic infection, inflammatory syndromes, or infections in the 3 months before the study, (4) not taking corticosteroids, and (5) willing to participate in the study as evidenced by signing of an informed consent. INTERVENTION Serum TTR, albumin, blood urea nitrogen, creatinine, cholesterol, postdialysis weight and body mass index were measured monthly for 6 consecutive months. Normalized protein catabolic rate and KT/V were measured monthly for 3 consecutive months. MAIN OUTCOME MEASURES Nutrition and biochemical indices. RESULTS The overall mean TTR level was 32 mg/dL +/- 7 for the 6-month study period. Thirty-six percent of patients had mean TTR levels less than 30 mg/dL. TTR levels less than 30 mg/dL correlated significantly with urine outputs greater than 240 mL/24 hours, predialysis blood urea nitrogen < 18 mmol/L (<50 mg/dL), and normalized protein catabolic rate less than 0.8 g/kg/d (P < .05). A significant correlation was found between TTR and creatinine, albumin and loss of dry body weight (P < .05). Mean TTR levels less than 30 mg/dL were found in 33% of subjects with mean albumin levels greater than 35 g/L (>3.5 g/dL) and in 19% with mean albumin levels greater than 40 g/L (>4.0 g/dL). TTR levels were consistently lower in diabetics for all 6 months (statistically significant in 2 out of 6 months). CONCLUSION Measuring serial serum TTR levels in hemodialysis patients is a reliable method for identifying patients in need of nutrition intervention.

Current Availability and Consumption of Carrageenan-Containing Foods

Carrageenans appear on the FDAs GRAS list for food additives, however reports of adverse gastrointestinal and immunological consequences related to the consumption of food products containing carrageenan have been increasing. The goals of this study were to obtain current information on food industry use of carrageenans, the variety of foods into which they are incorporated, and estimate the level of human intake of carrageenans from these food products. Supermarkets, health food stores, and food manufacturers were surveyed to identify carrageenan-containing foods for the purpose of surveying consumers about their use of these products. One hundred ninety-eight carrageenan-containing food products were identified. A questionnaire was developed and used to collect demographic and food frequency data. These data when analyzed by demographic grouping revealed that the over 30-year-old, college-educated, female subject with normal to low body mass indices embodies the consumers most likely to have a high carrageenan intake.