Marsha Read

A Stage-of-Change Classification System Based on Actions and Beliefs Regarding Dietary Fat and Fiber

Purpose. The objectives of this study were to develop a stage-of-change classification system and to determine the degree to which various adult subgroups have adopted the behavioral changes necessary to achieve a low-fat and/or high-fiber diet as recommended by the Dietary Guidelines for Americans. Design. The study used a mail survey randomly sent to 7110 adults. Setting. The survey was conducted in 11 states and the District of Columbia. Subjects. The random sample included males and females over age 18. Of the eligible respondents, 3198 (51.5%) were included in this analysis, with 2004 and 2066 unambiguously classified into stages of change for fat and fiber, respectively. Measures. Stage of change was defined by an algorithm based on self-reported intent and behaviors to limit fat and/or increase fiber. Results. 45% of the respondents were classified as being in action/maintenance for fat and 38% for fiber. Women, older adults, individuals with advanced education, persons with diet-related chronic disease, people with higher levels of relevant nutrition knowledge and attitudes, and persons who indicated that health concerns were a primary influence on their diet were more likely to be in action/maintenance than other respondents. Conclusions. The algorithm in this study presents a model that more closely reflects the proportions of the adult population that have achieved low-fat diets and classifies a greater proportion in the preparation stage than classification systems in previous studies.

Calcium intake of Asian, Hispanic and white youth.

Objective: To examine calcium intake and food sources among Asian, white and Hispanic youth, in order to develop and target interventions to improve calcium intake. Methods: Cross-sectional survey with two 24-hour dietary recalls one week apart. Calcium intake was evaluated in 167 male and female adolescents of Asian, Hispanic and white ethnicity, ages 10–18 years, from six states. Main outcome measures were mean daily calcium intake (mg/day). Statistical analyses performed: t tests, Chi-square and analysis of variance for differences by age, ethnicity and gender, multiple regression of factors influencing calcium intake. Results: Overall median calcium intake was 938 mg/day with 868 mg/day for Asians, 1180 mg/day for whites and 896 mg/day for Hispanics. Daily milk intake was the primary predictor of calcium intake with Asian ethnicity and female gender each showing a negative association to calcium intake in multiple regression models. Conclusions: Milk intake was the primary factor positively influencing calcium intake, while Asian ethnicity and female gender negatively influenced calcium intake. Thus, interventions to improve calcium intake should focus on improving milk intake of Asians and females.

Reported Adoption of Dietary Fat and Finer Recommendations Among Consumers

OBJECTIVE To identify constraints in adopting dietary fat and fiber recommendations. DESIGN A questionnaire was mailed to a sample of the general population, a convenience sample of persons with heart disease and cancer in 11 states, and registered dietitians in 5 states. The survey included questions on demographic and attitudinal factors that were correlated with specific practices to reduce fat intake and increase fiber intake. SETTING From the general population sample of 6,206 eligible respondents (return rate of 51.5%), those selected were respondents who indicated that they would adopt a dietary recommendation if it were good for them (n = 2,682). Subsamples from the general population were matched to 362 registered dietitians and 147 persons with cancer or heart disease on selected demographic variables. Factors associated with adoption of specific behaviors were identified. STATISTICAL ANALYSIS PERFORMED Statistical analysis included chi 2, factor analysis, and analysis of variance. RESULTS The majority of persons who said they would adopt a fat-reducing behavior if it were good for their health reported practicing that behavior often or usually. More than 60% reported consuming whole grains; however, only 15% reported eating fruits and vegetables frequently. Among the general population sample, those more likely to practice a behavior had the following characteristics: female, college educated, older than 60 years, white, higher income, no children younger than 18 years, perceived health status as excellent, and absence of chronic disease. Registered dietitians and those with chronic disease were also more likely to follow dietary fat and fiber recommendations. APPLICATIONS Nutrition education messages that lead to increased consumption of dietary fiber need to be developed. Nutrition educators should provide strategies for consumers for increasing use of fruits and vegetables in all meals. Good taste and convenience are critical components. The food industry may assist by providing a wider array of convenience entrees or side dishes that feature produce and whole grains.

Dietary pattern changes of Asian immigrants

Abstract Migrant epidemiologic studies have shown that the risk of certain chronic diseases may be associated with changes in lifestyle. The process of immigration provides an opportunity to examine more closely dietary pattern changes. These changes then provide potential clues as to subsequent health conditions. Food preparation habits, food practices, and nutrition beliefs before and after immigration of 124 Asian immigrants (men 80, women 44) were surveyed. Results indicate that the post-immigration diet is a relatively low-fat (23.6% of total calories), high-carbohydrate (56.7% of total calories) and high-fiber (28.5 gm/d) diet. Comparison of the post-immigration diet to the pre-immigration diet, indicated a significant increase in the intake of cholesterol (from 265.8 to 305.85 Mg/d), fat (from 49.21 to 56.49 gm/d), especially saturated fat (from 14.09 to 18.23 gm/d) and monounsaturated fat (from 15.49 to 19.58 gm/d) intake; conversely there was a decrease in carbohydrate (from 324.9 to 300.3 gm/d) and fiber (from 32.9 to 28.5 gm/d) intake. It is concluded that: 1) upon immigration, the Asian immigrants increased fat and cholesterol intake, decreased CHO and fiber intake, 2) yet, by American standards, the Asian immigrants current diet is relatively low fat, high CHO and high fiber, and 3) further research is needed to study the health effects of these changes.

Diet fat and fiber knowledge, beliefs and practices are minimally influenced by health status

Over 2700 subjects were surveyed to determine if a particular disease condition resulted in better knowledge, beliefs and dietary practices in relation to fat and fiber intakes. Using discriminant analysis, it appeared that the presence of disease conditions could affect these aspects of fat and fiber intake, but the contribution was minimal. General overall nutrition knowledge was lower for subjects reporting osteoporosis, and knowledge of specific facts about fiber was significantly lower in hypertensive and heart disease subjects. Dietary practices related to selection of high fat food was poorer in hypertensives than normotensives. Those with heart disease and hypercholesterolemia had better knowledge about fat than those without this condition. Only subjects with heart disease had more appropriate beliefs toward diet fat and health than did other subjects. Dietary practices appeared to be a factor for only two disease conditions. Subjects self-reporting elevated blood cholesterol levels had more appropriate fiber and fat practices, and diabetics had better diet fiber practices than others. Using multiple regression analysis, older subjects had lower fat and higher fiber intakes, whereas those with greater BMI had poorer diet practices with respect to fat and fiber. Furthermore, the analysis indicated that individuals with the belief that fat or fiber intake could affect health and well-being, and those with better nutrition knowledge, had better dietary practices.

Vitamin and food supplement practices and nutrition beliefs of the elderly in seven Western states

Abstract A mail survey of 2,451 non-institutionalized subjects, including 595 sixty years or older living in seven Western state (Arizona, California, Colorado, Hawaii, New Mexico, Nevada and Washington) reported frequencies and factors associated with vitamin and mineral supplementation. Sixty percent of subjects over 60 years reported using one or more supplements with multiple vitamin, vitamin D and vitamin E being most frequently used (>50%). Reasons for use ranged from lack of vitamin in food to energy and/or tiredness. Sources of nutrition information cited most frequently were newspapers and books. The level of usage in the elderly is a major concern for health providers as well as the lack of information from professional resources.

Mineral supplementation practices of adults in seven western states

Seven western states (Arizona, California, Idaho, Nevada, New Mexico, Oregon, and Wyoming) were surveyed in 1986 to determine the extent of vitamin/mineral supplementation and dosage levels of single supplements. Questionnaires were mailed to 3,500 individuals. A 57.8% response rate was obtained from the deliverable surveys, with a sample size of 1,730. The sample consisted of 54% women and 46% men and was predominantly white (88.9%). Fifty-four percent of the sample consumed some type of supplement; multiple vitamin/minerals were consumed with the greatest frequency. For single supplements, vitamin C was reported with the greatest frequency (23.1%), followed by some type of calcium supplement (22.5%) and vitamin E (11.1%). More than 80% of the vitamin C users indicated a dosage of 250 mg/day. Most respondents consumed calcium dosages of less than 1,000 mg/day. For vitamin E, 75% of the users consumed more than 200 IU/day. The data suggest that the potential for toxicity due to excess supplementation levels exists in the western states studied.

Use of Herbal Supplements Reported by Older Adults in Congregate Meal Sites

A questionnaire gathered information on herbal supplement use in a convenience sample of 177 individuals who were age 50 or older. The qualitative data collected included use of herbal supplements, beliefs held about the efficacy of herbal supplements, self-reported health status, and general demographic information. The most commonly used herbal supplements were Echinacea, St Johns wort, gingko biloba, ginseng, kava kava, and saw palmetto. Reasons cited for using herbal supplements were stress, enhanced immune function, better sleep, and improved mood. Respondents commonly believed that herbal supplements were both efficacious and safer than over-the-counter medications. Such beliefs indicate the need for education, especially potential adverse effects.

Contribution of diet versus supplements to selected nutrient intake in the western region

Abstract The objective of this project was to assess the contributions made by diet and/or food supplements to the intake of vitamins and minerals. Results indicated that 30% of the respondents were meeting less than 67% of the 1989 Recommended Dietary Allowance (RDA) for calcium with diet alone or diet plus supplements. Of those who supplemented, 46 percent consumed (diet and supplements) vitamin C at levels greater than 150% of the 1989 RDA. Even when vitamin C intake was greater than the RDA of 60 mg, 40% took supplements averaging 689.2 mg/day. Although 37% of the people were meeting the highest RDA for both riboflavin and niacin, through food, all were consuming supplements. Research supported by the SAES Western Regional Project W-153.

Behavioral Intervention in Adolescents Improves Bone Mass, Yet Lactose Maldigestion Is a Barrier

Calcium intake during adolescence is important for attainment of peak bone mass. Lactose maldigestion is an autosomal recessive trait, leading to lower calcium intake. The Adequate Calcium Today study aimed to determine if a school-based targeted behavioral intervention over one year could improve calcium intake and bone mass in early adolescent girls. The school-randomized intervention was conducted at middle schools in six states over one school year. A total of 473 girls aged 10–13 years were recruited for outcome assessments. Bone mineral content (BMC) was determined by dual energy X-ray absorptiometry. Dietary calcium intake was assessed with a semi-quantitative food frequency questionnaire. Baseline calcium intake and BMC were not significantly different between groups. After the intervention period, there were no differences in changes in calcium intake and BMC at any site between groups. An unanticipated outcome was a greater increase in spinal BMC among lactose digesters than lactose maldigesters in the intervention schools only (12 months) (6.9 ± 0.3 g vs. 6.0 ± 0.4 g, p = 0.03) and considering the entire study period (18 months) (9.9 ± 0.4 vs. 8.7 ± 0.5 g, p < 0.01). Overall, no significant differences between the intervention and control schools were observed. However, lactose digesters who received the intervention program increased bone mass to a greater extent than lactose maldigesters.