Karen S. Kubena

Progress in the Development of a Nutritional Risk Index

The development of a 16-item nutritional risk index (NRI) is chronicled from its inception through its application in three studies designed to assess its reliability and validity. Study I involved a survey of 401 community-dwelling elderly in St. Louis, Missouri who were interviewed at baseline, 4-5 mo later, and 1 yr later. Study II involved a cross-sectional survey of 377 male outpatients attending two clinics at the St. Louis Veterans Administration Medical Center. Study III involved a cross-sectional survey of 424 community-dwelling elderly in Houston, Texas. Internal consistency reliability coefficients ranged between 0.47 and 0.60, and test-retest reliability coefficients ranged between 0.65 and 0.71. Validity was established by using the NRI to predict the use of health services, as well as by correlating it with a variety of anthropometric, laboratory, and clinical markers of nutritional status. The utility of the NRI for future applications is discussed.

Nutrition and the immune system: a review of nutrient-nutrient interactions.

Although research on the role of single nutrients in immune function is extensive, this is not the case for multiple nutrients and subsequent nutrient-nutrient interactions. After presenting a brief overview of immune function, the authors consider reports that examine imbalance of more than one nutrient and interactive effects on immunocompetence. Availability of one nutrient may impair or enhance the action of another in the immune system, as reported for nutrients such as vitamin E and selenium, vitamin E and vitamin A, zinc and copper, and dietary fatty acids and vitamin A. Nutrient-nutrient interactions may negatively affect immune function. For example, excess calcium interferes with leukocyte function by displacing magnesium ions, thereby reducing cell adhesion. Because of consumer interest in supplementation to improve immune function, the potential for harm exists. Research is needed to improve knowledge in this area so that recommendations can be made with more confidence.

Blood Lipids, Cardiovascular Fitness, Obesity and Blood Pressure - The Presence of Potential Coronary Heart Disease Risk Factors in Adolescents

OBJECTIVE To identify and compare the presence of coronary heart disease (CHD) risk factors among 14- and 15-year-old boys and girls. DESIGN For this cross-sectional study of 54 subjects, a blood sample taken after subjects fasted was used to determine total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride concentrations. Dietary intake was estimated using a 24-hour recall and a 2-day food record. Height, weight, and skinfold thicknesses were measured to identify obese and severely obese subjects. Cardiovascular fitness, blood pressure, and cigarette use also were measured. TC, HDL-C, LDL-C, fitness, blood pressure, and smoking are modifiable risk factors, for CHD. SUBJECTS Adolescents were selected by random sampling from lists of students attending public schools in two central Texas cities. Adolescents who were 14 or 15 years old; were not pregnant; and had no history of high blood pressure, diabetes, or heart disease were eligible to participate. STATISTICAL METHODS Data were analyzed using Students t and chi square tests. RESULTS Of the subjects, 25% demonstrated two or more risk factors for CHD. A significantly higher percentage of girls than boys had a TC concentration greater than 5.2 mmol/L. Boys (n=29) had a mean fitness score that indicated a higher level of cardiovascular fitness than girls (n=25); however, the mean score for both groups was below average. CONCLUSION Data provide support for increased interventions targeted toward lowering the risk factors for CHD and other chronic diseases in adolescents.

Effect of palm oil, margarine, butter, and sunflower oil on the serum lipids and lipoproteins of normocholesterolemic middle-aged men☆

Abstract Twenty-nine healthy middle-aged men participated in a Latin square-designed study containing six dietary fats: butter; crude palm oil; hard margarine; refined palm oil; 80% refined palm oil + 20% sunflower oil blend; and sunflower oil. Each diet period was 6 weeks in duration followed by 6 weeks of habitual diet. Test fats were consumed in ice cream, milk, cookies, and as spreads and represented 50% of the total fat energy (38%) on all diets. Serum lipid responses to the high level of test fats in the diets were small relative to habitual diet values. Large changes in quantity and type of fatty acids consumed daily were not reflected in the fatty acid composition of the total serum lipids. Butter did not elevate total serum cholesterol or low density lipoprotein (LDL) cholesterol relative to habitual diet levels, but these values were significantly higher than sunflower oil-diet and palm oil-diet values. The sunflower oil diet produced the most dramatic changes: total serum cholesterol was reduced significantly relative to all diets except margarine, and apolipoprotein B values were the lowest of any diet. Unfortunately, the desirable high density lipoprotein (HDL) cholesterol and apolipoprotein A1 were also reduced on the sunflower oil diet. Diets containing either crude or refined palm oil did not elevate total serum cholesterol relative to habitual diet values or LDL cholesterol or apolipoprotein levels relative to any diet. Unexpectedly, the refined palm oil diet HDL-cholesterol and apolipoprotein A1 levels were the highest of all diets and significantly higher than sunflower oil diet values. The hard margarine diet, containing 26% trans fatty acids, reduced apolipoprotein B values relative to habitual diet levels, but HDL cholesterol was reduced significantly relative to the refined palm oil diet values. Comparison of the diets fatty acid compositions suggests the decrease in the HDL cholesterol on the hard margarine diet is attributable to the trans fatty acids. The data indicate that the trans fatty acids, produced during the partial hydrogenation of fats and oils, are not neutral and adversely affect serum lipid profile.

The relationship of nutritional copper to the development of postmenopausal osteoporosis in rats

Factors that influence tissue copper concentration include age, diet, hormones, and pregnancy. In this study we altered diet independently, hormone (estrogen) independently, and various combinations of diet and hormone in animals of the same age to study the effects of ovariectomy complicated with dietary copper deficiency; a deficiency that has been demonstrated to cause bone defects. Sprague-Dawley rats were placed on various combinations of copper deficient or enriched diets before and /or after ovariectomy to determine if copper deficiency aggravated osteoporosis and if return to a copper-adequate diet alleviated it. In this study, ovariectomy did induce an osteopenia that was characterized by decreased trabecular bone. This osteopenia was slightly more severe with copper deficiency, but was not necessarily alleviated by the return of normal copper levels to the diet.

Factors associated with sources of influence/information in reducing red meat by elderly subjects

A number of studies have found that health beliefs and social influences predict changes in dietary intake, including red meat. These studies have not determined what kinds of individuals are more likely to change their diets due to the advice of physicians, the advice of significant others, or because of mass-media exposure. We obtained data from 424 elderly Houstonians regarding whether they had attempted to reduce red meat consumption and if so, why. Social network, health status, food attitude and demographic variables are used to differentiate those who have made physician-induced changes from other sources of influence/information for change. Elderly subjects with smaller abdominal girth measurements are more likely to make red meat reductions regardless of the source of influence/information; those who believe in the efficacy of health foods are more likely to give physicians and mass media as sources of influence/information for red meat reductions. Men are more likely than women to report red meat reductions because of mass media and physician influences. Women who receive a greater amount of companionship from their social networks are more likely to change because of friends/relatives influences.

Social Network and Social Background Characteristics of Elderly Who Live and Eat Alone

Solitary eating is increasingly viewed as a factor in nutritional risk for the aged. Similarly, those elderly who live alone are thought to be at risk. Using data drawn from 424 elderly Texans, the elderlys four possible living-eating arrangements were examined. Findings included the greater the number of companions and percentage of kin in the social network, the less likely are the elderly to both live and eat alone. Males, those with greater income, and those who are older are also less likely to live and eat alone. Those who live alone but eat with others are female, of low income, but of higher education than those elderly who both live and eat with others.

Life events, social support, and immune response in elderly individuals

One hundred ninety-two elderly men and women were investigated to determine the effects of recent life events, psychological adjustment, and social support on lymphocyte count, controlling for nutritional status, age, education, income, and the presence of lymphocyte-altering drugs. Effects of specific recent life events were found. For elderly males, recent sexual dysfunction lowers lymphocyte count, while psychological adjustment and percentage kin in the intimate network elevates it. For elderly females, the experience of either family or legal problems elevates lymphocyte count as does frequent interaction with members of the intimate network. These results suggest that life events have very different effects on elderly men and womens immune systems. Social support has direct but mediating effects on lymphocyte count for both genders.

The American family meal

Abstract In this chapter, the American family meal is examined. Recent trends in eating by both individuals and families are explored. Frequency of eating various meals, time spent eating, and which, if any, family members participate in these meals are studied. Effects of parental employment, income, and other characteristics indicate the frequency and time spent in some family meals are constrained by resources such as time and by parental work schedules. Foods currently consumed at family dinner tables are presented.

Religion, Social Support, Food-Related Social Support, Diet, Nutrition, and Anthropometrics in Older Adults

Religion is an important aspect of many peoples lives, especially for older adults. However, very little data exists about the relationships between religion, food-related social support, diet, nutrition, and anthropometrics in older U.S. adults. Social support may be a possible mechanism for religion-diet/nutrition relationships. This analysis examined these relationships in a sample of 424 older individuals. Religion was related to some dietary behaviors in men, and in dietary behaviors and anthropometrics in women. Religions relationship with anthropometrics as well as diet in women may have been due to womens greater religiousness and involvement in food acquisition, preparation, and distribution in religious gatherings.