Kaye Stanek Krogstrand

Half of rural girls aged 8 to 17 years report weight concerns and dietary changes, with both more prevalent with increased age

OBJECTIVE Determine body image satisfaction, weight concerns and dieting behaviors, Tanner index, and dietary adequacy in young women and girls. DESIGN A cross-sectional, self-selected comparative survey was completed. SUBJECTS/SETTING Rural white women and girls (N=333) aged 8 to 17 years, completed a weight concerns and dieting behavior questionnaire, a body image assessment, and a self-rating of sexual maturity, and 230 subjects completed 3-day diet diaries. ANALYSES PERFORMED: Correlational analysis identified relationships between variables among age groups (8 to 10 years, 11 to 14 years, and 15 to 17 years). Analysis of variance examined differences among variables. Multiple regression analysis measured the influence of variables on diet quality. A mean adequacy ratio (MAR) was computed to express dietary adequacy. RESULTS More than half (52%) of the subjects reported 1 or more weight concerns and dieting behaviors. This pattern increased with age. Friends dieting positively influenced scores (P=.0001) for 8- to 14-year olds, and a dieting family member meant higher scores (P=.04) for all ages studied. Although most wanted to be smaller, there was little body image dissatisfaction. Girls (aged 11 to 17 years) who dieted had greater body dissatisfaction (P=.0001) and significantly lower (P=.002), but adequate diets (MAR=76) compared to those who did not diet (MAR=81). Inverse relationships were found for the 11- to 14-year olds with diet adequacy and the following variables: body image dissatisfaction (-2.7, P<.01) and weight concerns and dieting behaviors (-3.7, P<.001). These variables accounted for 34% (P=.0001) of the variance in the MAR. APPLICATIONS/CONCLUSIONS Dietitians, partnering with school and health clinic personnel, need to educate girls younger than age 11 years about attaining the dietary adequacy needed to support expected growth. This age is important because it appears that actual weight and dieting concerns begin earlier, and by age 11 years, negatively affect diet quality.

Stearate-Enriched Plant Sterol Esters Lower Serum LDL Cholesterol Concentration in Normo- and Hypercholesterolemic Adults

Studies in our laboratory have previously demonstrated in hamsters a superior cholesterol-lowering ability of plant sterol (PS) esters enriched in stearate compared with linoleate. We therefore conducted a randomized, double-blind, 2-group parallel, placebo-controlled study to test the cholesterol-lowering properties of stearate-enriched PS esters in normo- and hypercholesterolemic adults. Thirty-two adults, 16 per group with equal number of males and females in each group, participated in the 4-wk study. Participants consumed 3 g/d (1 g three times per day with meals) of either PS esters or placebo delivered in capsules. Serum LDL cholesterol concentration significantly decreased 0.42 mmol/L (11%) and the LDL:HDL cholesterol ratio decreased 10% with PS ester supplementation, whereas LDL particle size and lipoprotein subclass particle concentrations (as measured by NMR) were not affected. The percent change in LDL cholesterol was positively correlated with baseline lathosterol concentration (r = 0.729; P = 0.0014), indicating an association between the magnitude of LDL change and the rate of whole-body cholesterol synthesis. Serum campesterol (but not sitosterol) concentration significantly increased in the PS ester group. Serum tocopherol, retinol, and beta-carotene concentrations were not affected by PS ester supplementation. Thus, our findings demonstrate the usefulness of a novel stearate-enriched PS ester compound in decreasing LDL cholesterol in both normo- and hypercholesterolemic adults. The extent to which PS ester fatty acid composition affects intestinal micelle formation and cholesterol absorption in humans requires further study.

Race/Ethnicity and Income in Relation to the Home Food Environment in US Youth Aged 6 to 19 Years

BACKGROUND The home food environment is complex and has the potential to influence dietary habit development in young people. Several factors may influence the home food environment, including income and race/ethnicity. OBJECTIVE To examine the relationship of income and race/ethnicity with three home food environment factors (ie, food availability frequency, family meal patterns [frequency of family and home cooked meals], and family food expenditures). DESIGN A cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES). PARTICIPANTS A total of 5,096 youth aged 6 to 19 years from a nationally representative sample of US individuals participating in NHANES 2007-10. STATISTICAL ANALYSES PERFORMED Prevalence of food availability frequency was assessed for the entire sample, race/ethnicity, poverty income ratio (PIR), and race/ethnicity stratified by PIR. Mean values of family meal patterns and food expenditures were calculated based on race/ethnicity, PIR, and race/ethnicity stratified by PIR using analysis of variance and least squares means. Tests of main effects were used to assess differences in food availability prevalence and mean values of family meal patterns and food expenditures. RESULTS Non-Hispanic whites had the highest prevalence of salty snacks (51.1%±1.5%) and fat-free/low-fat milk (39.2%±1.7%) always available. High-income homes had the highest prevalence of fruits (75.4%±2.4%) and fat-free/low-fat milk (38.4%±2.1%) always available. Differences were found for prevalence of food availability when race/ethnicity was stratified by PIR. Non-Hispanic blacks had the lowest prevalence of fat-free/low-fat milk always available across PIR groups. Differences in mean levels of family meal patterns and food expenditures were found for race/ethnicity, PIR, and race/ethnicity stratified by PIR. CONCLUSIONS Race/ethnicity and PIR appear to influence food availability, family meal patterns, and family food expenditures in homes of youth. Knowledge of factors that influence the home food environment could assist in developing effective strategies to improve food environments for young people.

Effects of partners together in health intervention on physical activity and healthy eating behaviors: a pilot study.

Background:Despite proven efficacy of cardiac rehabilitation (CR) in helping patients initiate physical activity and healthy eating changes, less than 50% of CR participants maintain changes 6 months later. Objective:The objective of this feasibility study was to test the Partners Together in Health (PaTH) intervention versus usual care in improving physical activity and healthy eating behaviors in coronary artery bypass graft surgery patients and their spouses. Methods:An experimental, 2-group (n = 17 couples/group), repeated-measures design was used. Coronary artery bypass surgery patients in both groups participated in phase II outpatient CR. Spouses in the PaTH group attended CR with the patient and were asked to make the same physical activity and healthy eating changes as patients did. Spouses in the usual care attended educational classes with patients. It was theorized that “2 persons would be better than 1” at making changes and sticking with them in the long-term. Physical activity behavior was measured using the Actiheart accelerometer; the activity biomarker was an exercise tolerance test. Eating behavior was measured using 3-day food records; the biomarker was the lipid profile. Data were collected at baseline (entrance in CR), at 3 months (post-CR), and at 6 months. Changes over time were examined using Mann-Whitney U statistics and effect sizes. Results:The PaTH intervention was successful primarily in demonstrating improved trends in healthy eating behavior for patients and spouses. No differences were found between the PaTH and usual care patients or spouses at 3 or 6 months in the number of minutes per week of physical activity. By 6 months, patients in both groups were, on average, below the national guidelines for PA recommendations (≥150 min/wk at >3 metabolic equivalents). Conclusions:The couple-focused PaTH intervention demonstrated promise in offsetting the decline in dietary adherence typically seen 6 months after CR.

Intervention Fidelity in a Translational Study: Lessons Learned

This article examined the intervention fidelity strategies used and lessons learned in a translational study. In this study, the behavioral intervention was delivered within an existing clinical practice environment, outpatient cardiac rehabilitation (CR). The primary lessons learned were that the fidelity components of design, training, and delivery of the intervention were the most different from fidelity strategies used in typical intervention studies. The design component needed to take into account the unique characteristics of the clinical environments where the study was conducted and build these unique differences into the study design. Training and delivery of the intervention was different because existing CR staff delivered the intervention in this study; which is unlike typical intervention studies where research staff are trained to deliver the intervention. Monitoring receipt and enactment fidelity components were similar to monitoring in usual intervention studies probably because these components focus on monitoring the behaviors of the research participant. Translational research presents unique challenges and requires the development of a flexible and novel intervention fidelity plan tailored to a particular study.