Obesity affects one in three American adult women and is associated with overall mortality and major morbidities. A composite diet index to evaluate total diet quality may better assess the complex relationship between diet and obesity, providing insights for nutrition interventions. The purpose of the present investigation was to determine whether diet quality, defined according to the previously validated Framingham nutritional risk score (FNRS), was associated with the development of overweight or obesity in women. Over 16 years, we followed 590 normal-weight women (BMI < 25 kg/m 2 ), aged 25 to 71 years, of the Framingham Offspring and Spouse Study who presented without CVD, cancer or diabetes at baseline. The nineteen-nutrient FNRS derived from mean ranks of nutrient intakes from 3 d dietary records was used to assess nutritional risk. The outcome was development of overweight or obesity (BMI ≥ 25 kg/m 2 ) during follow-up. In a stepwise multiple logistic regression model adjusted for age, physical activity and smoking status, the FNRS was directly related to overweight or obesity ( P for trend = 0·009). Women with lower diet quality (i.e. higher nutritional risk scores) were significantly more likely to become overweight or obese (OR 1·76; 95 % CI 1·16, 2·69) compared with those with higher diet quality. Diet quality, assessed using a comprehensive composite nutritional risk score, predicted development of overweight or obesity. This finding suggests that overall diet quality be considered a key component in planning and implementing programmes for obesity risk reduction and treatment recommendations.
To evaluate the acceptability and feasibility of a scalable obesity treatment program integrated with pediatric primary care (PC) and delivered using interactive voice technology (IVR) to families from underserved populations.Fifty parent-child dyads (child 9-12 yrs, BMI > 95th percentile) were recruited from a pediatric PC clinic and randomized to either an IVR or a wait-list control (WLC) group. The majority were lower-income, African-American (72%) families. Dyads received IVR calls for 12 weeks. Call content was informed by two evidence-based interventions. Anthropometric and behavioral variables were assessed at baseline and 3-month follow-up.Forty-three dyads completed the study. IVR parents ate one cup more fruit than WLC (P < 0.05). No other group differences were found. Children classified as high users of the IVR decreased weight, BMI, and BMI z-score compared to low users ( P < 0.05). Mean number of calls for parents and children were 9.1 (5.2 SD) and 9.0 (5.7 SD), respectively. Of those who made calls, >75% agreed that the calls were useful, made for people like them, credible, and helped them eat healthy foods.An obesity treatment program delivered via IVR may be an acceptable and feasible resource for families from underserved populations.
Childhood obesity is rising and dietary intake is a potentially modifiable factor that plays an important role in its development. We aim to investigate the association between dietary patterns, obtained through principal components analysis and gains in fat and lean mass in childhood.Diet diaries at 10 years of age collected from children taking part in the Avon Longitudinal Study of Parents and Children. Body composition was assessed using dual-energy X-ray absorptiometry at 9 and 11.Longitudinal birth cohort.3911 children with complete data.There was an association between the Health Aware (positive loadings on high-fiber bread, and fruits and vegetables; negative loadings on chips, crisps, processed meat, and soft drinks) pattern score and decreased fat mass gain in girls. After adjusting for confounders, an increase of 1 standard deviation (sd) in this score led to an estimated 1.2% decrease in fat mass gain in valid-reporters and 2.1% in under-reporters. A similar decrease was found only in under-reporting boys. There was also an association between the Packed Lunch (high consumption of white bread, sandwich fillings, and snacks) pattern score and decreased fat mass gain (1.1% per sd) in valid-reporting but not under-reporting girls. The main association with lean mass gain was an increase with Packed Lunch pattern score in valid-reporting boys only.There is a small association between dietary patterns and change in fat mass in mid-childhood. Differences between under- and valid-reporters emphasize the need to consider valid-reporters separately in such studies.
What are cereal grains and “pseudograins”? Grains like wheat, corn, oats, and rice are cereal grasses, the fruit or seed of the grass family; many grains are thus referred to as “cereals.” Some plants from the broadleaf family, like amaranth, buckwheat, and quinoa, are...
The Pediatric Residency Review Committee requires programs to provide a curriculum that advances residents' knowledge of the basic principles of research. In July 2002, the Boston Combined Residency Program instituted a 3-month career-development block (CDB) rotation. During the rotation residents pursue an academic or clinical project under mentorship by a faculty member.Our objective for this study was to evaluate the outcome of the CDB rotation since it was implemented.A survey was administered to 165 residents who completed the CDB rotation.Of 165 residents, 136 (82%) responded to the survey. Of 122 residents who reported the type of project they conducted, 59 (48%) completed a clinical/health services project, 24 (20%) completed a project in education or curriculum development, and 7 (6%) worked in basic science. Thirty-five residents (27%) received funding to support their work. Thirty-five residents (26%) presented at national meetings such as the Pediatric Academic Societies Meeting. Fifteen (11%) residents have had manuscripts accepted for publication, and 22 (16%) additional residents have submitted manuscripts for publication. Factors associated with successful publication included having received funding (odds ratio: 3.37 [95% confidence interval: 1.34-8.42]) and the nature of the research project (odds ratio: 3.55 [95% confidence interval: 1.40-9.04]). The majority of residents (84%) stated that the CDB rotation enhanced residency training.A dedicated academic rotation that includes protected time, senior faculty mentorship, and program funding, can lead to productive research accomplishments by pediatric residents. Support of academic work during residency training may encourage engagement in a variety of academically oriented activities.
The relationship between central and total fat measured by anthropometry, dual energy X-ray absorptiometry, and magnetic resonance imaging (MRI) with each other and systolic blood pressure (SBP) was examined.Participants of the Avon Longitudinal Study of Parents and Children were examined at ages 9, 11, 13, and 15 years (n = 3,796-6,567). MRI was available on a subset of children at 11 (n = 156) and 13 (n = 95).Body mass index (BMI) and waist circumference (WC) were highly correlated (r = 0.84-0.91, across ages), and total body fat mass (TBFM) and trunk fat mass (TFM) were very strongly correlated (r ≥ 0.98). Among boys, BMI vs. WC explained a similar degree of variation in TBFM and TFM (41-71% vs. 43-76%, across age and overweight groups); in girls, BMI accounted for 62-73% variance and WC 47-69%. Adiposity measures were generally similarly correlated with SBP within age groups. Further, the relationship between intra-abdominal adipose tissue (IAAT) volume and adiposity measures did not vary greatly at 11 (0.65-0.67) and 13 (0.64-0.67).BMI and WC contain a large amount of overlapping information as evidenced by their high correlation and similarly sized associations with fat mass, SBP, and IAAT. This suggests that WC may be an inadequate marker of central adiposity during childhood.
Abstract Objective Major depressive disorder (MDD) during pregnancy increases the risk of adverse maternal and infant outcomes. Maternal nutritional status may be a modifiable risk factor for antenatal depression. We evaluated the association between patterns in mid-pregnancy nutritional biomarkers and MDD. Design Prospective cohort study. Setting Pittsburgh, Pennsylvania, USA. Subjects Women who enrolled at ≤20 weeks’ gestation and had a diagnosis of MDD made with the Structured Clinical Interview for DSM-IV ( Diagnostic and Statistical Manual of Mental Disorders , 4th edition) at 20-, 30- and 36-week study visits. A total of 135 women contributed 345 person-visits. Non-fasting blood drawn at enrolment was assayed for red cell essential fatty acids, plasma folate, homocysteine and ascorbic acid; serum 25-hydroxyvitamin D, retinol, vitamin E, carotenoids, ferritin and soluble transferrin receptors. Nutritional biomarkers were entered into principal components analysis. Results Three factors emerged: Factor 1, Essential Fatty Acids; Factor 2, Micronutrients; and Factor 3, Carotenoids. MDD was prevalent in 21·5 % of women. In longitudinal multivariable logistic models, there was no association between the Essential Fatty Acids or Micronutrients pattern and MDD either before or after adjustment for employment, education or pre-pregnancy BMI. In unadjusted analysis, women with factor scores for Carotenoids in the middle and upper tertiles were 60 % less likely than women in the bottom tertile to have MDD during pregnancy, but after adjustment for confounders the associations were no longer statistically significant. Conclusions While meaningful patterns were derived using nutritional biomarkers, significant associations with MDD were not observed in multivariable adjusted analyses. Larger, more diverse samples are needed to understand nutrition–depression relationships during pregnancy.
Introduction: Previous investigations of the association of a healthy dietary pattern, the Mediterranean (Med) diet, and risk of sudden cardiac death (SCD) are limited and generally have not examined possible differences in those with and without a history of coronary heart disease (CHD). Studies of the associations of a posteriori -derived dietary patterns and risk of SCD are lacking. We conducted analyses of the associations of these dietary patterns with risk of SCD in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Hypothesis: We hypothesized that the Med diet score and adherence to the plant-based dietary pattern would be inversely associated with risk of SCD, adherence to the convenience and Southern dietary patterns would be positively associated with risk of SCD, and that these associations would differ by history of CHD. Methods: REGARDS enrolled 30,239 white and black adults aged ≥45 years from 2003-2007. Participants completed a food frequency questionnaire at baseline, from which 5 dietary patterns were derived through factor analysis: convenience, plant-based, sweets, Southern, and alcohol and salads. Med diet scores were calculated and categorized into 3 groups. SCD events were expert adjudicated. Cox proportional hazards regression was used to model the associations of the dietary patterns and score with SCD events, adjusting for sociodemographics, lifestyle factors, energy intake, anthropometrics, medical conditions, and medications, and stratifying by history of CHD. Results: After excluding participants with missing diet and covariate data and those lost to follow-up, 21,066 participants were included in the analysis. Mean (SD) age was 64.9 (9.3) years, 56.0% were women, 33.2% were black, and 385 (1.8%) experienced SCD during a mean (SD) follow-up of 9.2 (3.4) years. In those without a history of CHD, Med diet score was significantly and inversely associated with risk of SCD (hazard ratio [HR] for group 3 vs. group 1 [referent]: 0.55; 95% confidence interval [CI]: 0.35-0.89; p trend = 0.02), but none of the a posteriori -derived dietary patterns were associated with risk of SCD. However, in those with a history of CHD, Med diet score was not associated with risk of SCD, but the convenience dietary pattern was significantly and positively associated with risk of SCD (HR for quartile 4 vs. quartile 1 [referent]: 1.74; 95% CI: 1.08-2.78; p trend = 0.04), and the sweets dietary pattern was significantly and inversely associated with risk of SCD (HR for quartile 4 vs. quartile 1: 0.56; 95% CI: 0.33-0.94; p trend = 0.01). Conclusions: The associations of dietary patterns with risk of SCD in REGARDS participants differed by history of CHD.
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