Teresa Carithers

Validity and Calibration of Food Frequency Questionnaires Used with African-American Adults in the Jackson Heart Study

OBJECTIVE To examine the relative validity of two food frequency questionnaires (FFQs) developed for use in investigating diet and disease relationships within the adult African-American population in the southern United States. DESIGN Cross-sectional analyses of dietary nutrient intake data, comparing four 24-hour dietary recalls with an FFQ developed by the Lower Mississippi Delta Nutrition Intervention Research Initiative, and its shorter version adapted for use in the Jackson Heart Study. SUBJECTS A representative subset of participants (n=499, aged 35 to 81 years) from the baseline Jackson Heart Study cohort (N=5,302) was selected for this study. Data collection took place between winter 2000 and spring 2004. STATISTICAL ANALYSES Pearsons correlation coefficients (energy adjusted and de-attenuated) for 26 nutrients estimates from each of the FFQs, comparing them with the mean of four 24-hour dietary recalls. The ability of the FFQs to rank individuals based on nutrient intakes was compared to that of the mean of four 24-hour dietary recalls and attenuation coefficients were also calculated. RESULTS Median nutrient intake estimates tended to be higher on the long and lower on the short FFQ compared to the median for the mean of four 24-hour dietary recalls. Energy adjusted and deattenuated correlations of FFQ intake estimates with recalls ranged from 0.20 for sodium to 0.70 for carbohydrate for the short FFQ and from 0.23 for polyunsaturated fat to 0.75 for dietary fiber and magnesium for the long. Attenuation coefficients for men on average were 0.42 for the short and 0.49 for the long FFQ. For women, these were 0.31 for the short and 0.42 for the long FFQ. CONCLUSIONS Both FFQs appear to be reasonably valid for assessment of dietary intake of adult African Americans in the South. The Lower Mississippi Delta Nutrition Intervention Research Initiative FFQ exhibited higher intake estimates and stronger correlations with recalls than the Jackson Heart Study FFQ for most nutrients analyzed, more so for women than men.

A regional food-frequency questionnaire for the US Mississippi Delta

OBJECTIVE To describe food sources of nutrient intake for white and African American adults in the Lower Mississippi Delta (LMD), and their use in the development of a regional food-frequency questionnaire (FFQ) based on an earlier version of the National Cancer Institutes Health Habits and History Questionnaire. DESIGN We ranked food sources of energy, macronutrients, vitamins and minerals, and examined portion size distributions for 842 white and 857 African American residents aged 19 years and older, using 24-hour dietary intake recall data from a telephone survey of 36 LMD counties. These values were used to develop a regional FFQ, which was then field-tested with 100 subjects and revised to improve interpretability. SETTING The LMD region of the USA. SUBJECTS White and African American adult residents of the LMD. RESULTS LMD African Americans obtained more of their energy and nutrient intakes from poultry, processed meat, salty snacks, fruit drinks, pork and cornbread; and less from milk, alcohol, legumes, salad dressing, butter/margarine and sweetened tea than did white residents. Regional foods not on nationally used FFQs included grits, turnip greens, okra, ham hocks, chitterlings, crawfish, catfish, cracklings, jambalaya, potato logs, chicken and dumplings, and sweet potato pie. Based on responses during field-testing, the questionnaire was also designed to add four portion sizes for each food item, presented as questions, rather than in grid format. CONCLUSIONS Regional food use patterns differ from national patterns and furthermore differ between African American and white adults in the LMD. The resulting Delta NIRI FFQ for Adults should contribute to improved assessment of usual intake for use in studies of diet and health in this region.

Obesity, physical inactivity, and risk for cardiovascular disease.

Despite considerable progress in understanding disease mechanisms and risk factors, improved treatments, and public education efforts, cardiovascular disease (CVD) remains the leading cause of death in the United States. Obesity and physical inactivity, 2 important lifestyle-related risk factors for CVD, are prevalent in the southeastern United States and are becoming more prevalent in all racial groups and areas of the country. In reviewing these risk factors, we explored topics including prevalence and trends in population data; associated psychosocial and environmental factors; and some of the mechanisms through which these risk factors are thought to contribute to CVD. We identified significant, but as yet poorly understood, racial disparities in prevalence of obesity, low levels of physical activity, and correlates of these risk factors and examined important differences in the complex relationship between obesity, diabetes, and cardiovascular disease risk between African American and European American women. The Jackson Heart Study will provide important and unique information relevant to many unanswered questions about obesity, physical inactivity, and obesity in African Americans.

Carotenoid intakes, assessed by food-frequency questionnaires (FFQs), are associated with serum carotenoid concentrations in the Jackson Heart Study: validation of the Jackson Heart Study Delta NIRI Adult FFQs

OBJECTIVES Intake and status of carotenoids have been associated with chronic disease. The objectives of this study were to examine the association between carotenoid intakes as measured by two regional food-frequency questionnaires (FFQs) and their corresponding measures in serum, and to report on dietary food sources of carotenoids in Jackson Heart Study (JHS) participants. DESIGN Cross-sectional analysis of data for 402 African American men and women participating in the Diet and Physical Activity Sub-Study (DPASS) of the JHS. RESULTS Mean serum carotenoid concentrations and intakes in this population were comparable to those reported for the general US population. After adjustment for covariates, correlations between serum and dietary measures of each carotenoid, for the average of the recalls (deattenuated), the short FFQ and the long FFQ, respectively, were: 035 and 0-carotene; 026 and 0-carotene; 017 and 0-carotene; 034 and 0-cryptoxanthin; 015 and 037, 014 for lycopene. Major dietary sources of -carotene and lutein plus zeaxanthin, mustard, turnip and collard greens; of beta-cryptoxanthin, orange juice; and of lycopene, tomato juice. CONCLUSIONS On average, carotenoid intakes and serum concentrations are not lower in this southern African American population than the general US population. The two regional FFQs developed for a southern US population and used as dietary assessment tools in the JHS appear to provide reasonably valid information for most of these carotenoids.

Dietary Patterns, Abdominal Visceral Adipose Tissue and Cardiometabolic Risk Factors in African Americans: the Jackson Heart Study

To examine the relative association of abdominal visceral adipose tissue (VAT) with cardiometabolic risk factors between African and European Americans.

Total Antioxidant Performance Is Associated with Diet and Serum Antioxidants in Participants of the Diet and Physical Activity Substudy of the Jackson Heart Study

Total antioxidant performance (TAP) measures antioxidant capacities in both hydrophilic and lipophilic compartments of serum and interactions known to exist between them. Our objective was to assess TAP levels in a subset of Jackson Heart Study (JHS) participants and to examine associations with dietary and total (diet + supplement) intakes of alpha-tocopherol, gamma-tocopherol (diet only), beta-carotene, vitamin C, fruit, vegetables, and nuts, and serum concentrations of alpha-tocopherol, gamma-tocopherol, and beta-carotene. We conducted a cross-sectional analysis of 420 (mean age 61 y; 254 women) African American men and women participating in the Diet and Physical Activity Sub-Study of the JHS in Jackson, Mississippi. In multivariate-adjusted models, we observed positive associations between total alpha-tocopherol, total and dietary beta-carotene, and total vitamin C intakes and TAP levels (P-trend < 0.05). Positive associations were also observed for vegetable, fruit, and total fruit and vegetable intakes (P-trend < 0.05). For serum antioxidant nutrients, alpha-tocopherol but not beta-carotene was associated with serum TAP levels. There were inverse associations for serum gamma-tocopherol and TAP levels. Associations for alpha-tocopherol were seen at intake levels much higher than the current Recommended Dietary Allowance. It may, therefore, be prudent to focus on increasing consumption of fruit, vegetables, nuts, and seeds to increase total antioxidant capacity.

Serum Carotenoid and Tocopherol Concentrations Vary by Dietary Pattern among African Americans

BACKGROUND Intakes and biochemical concentrations of carotenoids and tocopherols have been associated with chronic diseases. OBJECTIVE To describe dietary patterns in Jackson Heart Study participants and to determine if biochemical measurements of antioxidants differ across these. DESIGN Cross-sectional analysis of data for 373 African-American men and women (age 35 to 80 years), participating in the Diet and Physical Activity Substudy of the Jackson Heart Study. METHODS Dietary intake was assessed with a region specific food frequency questionnaire. Patterns were defined by cluster analysis of food groups, as percent of energy intake. RESULTS Four dietary patterns were identified: fast food, Southern, prudent, and juice. Individuals in the fast-food pattern (n=153) had significantly lower serum concentrations of lutein plus zeaxanthin and beta-cryptoxanthin; those in the Southern cluster (n=99) had significantly lower serum alpha-carotene; and those in the prudent (n=63) and juice (n=58) clusters had significantly higher serum alpha-carotene and beta-cryptoxanthin (P<0.05) relative to those in at least one other cluster (all P<0.05). The juice cluster also had higher serum alpha-tocopherol concentrations relative to the fast-food cluster. CONCLUSIONS Diets high in fast foods, snacks, soft drinks, and meat were associated with relatively low concentrations of carotenoids and alpha-tocopherol. This pattern contained the largest number of participants, and could contribute to the extensive health disparities seen in this region.

Pedometer determined physical activity tracks in African American adults: The Jackson Heart Study

BackgroundThis study investigated the number of pedometer assessment occasions required to establish habitual physical activity in African American adults.MethodsAfrican American adults (mean age 59.9 ± 0.60 years; 59 % female) enrolled in the Diet and Physical Activity Substudy of the Jackson Heart Study wore Yamax pedometers during 3-day monitoring periods, assessed on two to three distinct occasions, each separated by approximately one month. The stability of pedometer measured PA was described as differences in mean steps/day across time, as intraclass correlation coefficients (ICC) by sex, age, and body mass index (BMI) category, and as percent of participants changing steps/day quartiles across time.ResultsValid data were obtained for 270 participants on either two or three different assessment occasions. Mean steps/day were not significantly different across assessment occasions (p values > 0.456). The overall ICCs for steps/day assessed on either two or three occasions were 0.57 and 0.76, respectively. In addition, 85 % (two assessment occasions) and 76 % (three assessment occasions) of all participants remained in the same steps/day quartile or changed one quartile over time.ConclusionThe current study shows that an overall mean steps/day estimate based on a 3-day monitoring period did not differ significantly over 4 – 6 months. The findings were robust to differences in sex, age, and BMI categories. A single 3-day monitoring period is sufficient to capture habitual physical activity in African American adults.

Physical activity, body mass index and waist circumference change, and normal-range glycated hemoglobin on incident diabetes: Jackson Heart Study

ABSTRACT Objectives: The purpose of this study was to 1) evaluate whether physical activity has a protective effect on incident diabetes among African Americans across combinations of body mass index (BMI) and waist circumference (WC), 2) evaluate the effect of changes on BMI and WC on incident diabetes, and 3) evaluate the effect of ‘normal range’ glycated hemoglobin (A1C) on incident diabetes. Methods: Data from the prospective Jackson Heart Study were evaluated, with baseline data assessed between 2001 and 2004 and follow-up data occurring between 2009 and 2013. Physical activity was assessed via a validated questionnaire, with measured BMI, WC and A1C assessed via standard procedures. Results: The sample included 2,450 adults who did not have evidence of diabetes at the baseline assessment, with 286 incident diabetes cases occurring at the follow-up assessment. Physical activity did not have a protective effect against incident diabetes across different BMI and WC combinations. Notably, BMI change from baseline to follow-up was associated with incident diabetes (HR = 1.08; 95% CI: 1.03–1.13). Further, higher levels of A1C within the ‘normal-range’ was associated with incident diabetes (HR = 7.51, 95% CI = 2.66–21.25). Conclusion: Increases in BMI over time and higher A1C within the normal range were associated with incident diabetes. Serial monitoring of BMI, as well as A1C, even among those with a ‘normal’ A1C, may be warranted by clinicians. Future work evaluating this novel three-way model (physical activity, BMI and WC) should consider utilizing an objective measure of physical activity.

Association of kidney stones with atherosclerotic cardiovascular disease among adults in the United States: Considerations by race-ethnicity

BACKGROUND There is a paucity of research examining the relationship between kidney stones and risk of cardiovascular disease while considering individuals of different race-ethnicities. PURPOSE The purpose of this study was to examine the association between history of kidney stones and increased odds of atherosclerotic cardiovascular disease (via the Pooled Cohort Equations) across race-ethnicity groups. METHODS 5571 participants aged 40-79 from the 2007-2012 cycles of the NHANES were used for this study. A history of kidney stones was collected from survey data. Predicted odds of having a 10-year atherosclerotic cardiovascular disease (ASCVD) event was assessed from the Pooled Cohort Equations. RESULTS After adjustments, having kidney stones was not associated with an increase odds of having an ASCVD event within the next 10-years (OR 1.03; 95% CI: 0.58-1.82, P=0.91). However, among non-Hispanic blacks, those with kidney stones had a 2.24 increased odds (OR 2.24; 95% CI: 1.08-4.66; P=0.03) of having an ASCVD event within the next 10-years when compared to non-Hispanic blacks with no history of a kidney stone. CONCLUSION Kidney stones were associated with 10-year risk of a future ASCVD event among non-Hispanic blacks.