Biomedical subjects

B M Popkin

Publications and source records attributed to B M Popkin.

At least 19 recordsLinked to original sources

PubMed1999

Dietary patterns and trends in the United States: the UNC-CH approach.

Over the past 2 decades our group of nutrition and economics researchers at the University of North Carolina at Chapel Hill has used a wide array of methods to study eating patterns and dietary trends. Our focus has been on characterising the way diet has changed over time and identifying some of the major factors underlying these trends. The complexity of this undertaking has led us to develop a number of unique systems for classifying foods and assessing the overall quality of diet. We have also addressed the challenges that exist when measuring changes in both the food supply and food-related behaviors over time. This paper summarises some of the methodological work related to food grouping, overall diet quality indices, and trends research as well as the challenges we still face in this arena.

Diet↗

PubMed1998

Measurement error in dietary data: implications for the epidemiologic study of the diet-disease relationship.

OBJECTIVES: To examine the effect of measurement error in dietary data on the relationship between diet and body mass index (BMI). To correct for the effect of measurement error on diet-BMI association by using replicate measurements of diet. The effect of measurement error on diet--BMI relationship was simulated, and its implications are discussed. DESIGN: Prospective study design. SETTING: The first and second China Health and Nutrition Survey conducted in 1989 and 1991, respectively. SUBJECTS: Three thousand, four hundred and seventy-nine adults age 20-45 y at the 1989 survey. METHODS: Statistical methods were used to demonstrate the effect of measurement error in dietary data on the diet-BMI association. RESULTS: By using the average of three replicate 24 h dietary recalls, the attenuation of diet-BMI association was reduced substantially. The regression coefficients of fat and energy intakes differed markedly from those computed by using only single measurement of diet. CONCLUSIONS: Measurement error in dietary data may significantly attenuate the diet-disease association. Where appropriate, specific emphasis may be needed to address the problem of measurement error in the study of diet-disease relationship.

Adult↗

PubMed1998

Changes in diet and physical activity affect the body mass index of Chinese adults.

OBJECTIVE: To examine the relationship between diet, particularly dietary fat intake, and body mass index (BMI). DESIGN: Prospective study of adults who participated in the 1989 and 1991 China Health and Nutrition Survey. SUBJECTS: 3484 adults aged 20-45 at baseline (1989) survey. MEASUREMENTS: Measurement of dietary intake with replicated 24 h dietary recalls. Anthropometric measurements. Measurements of physical activity, smoking habit and socio-economic factors. RESULTS: Change in fat intake was positively associated with change in BMI in men (beta=0.00036, P=0.0001), and change in physical activity level was inversely associated with change in BMI in women (beta=-0.12, P=0.02). Energy intake, physical activity and major socio-economic factors were related to BMI in cross-sectional analysis. CONCLUSIONS: Diet is becoming an increasingly important determinant of body weight in this population, where fat and energy consumption has been increasing steadily during the past decade.

Adult↗

PubMed1998

Trends in breakfast consumption for children in the United States from 1965-1991.

We examined breakfast consumption patterns and trends between 1965 and 1991 for children (1-10 y old) and adolescents (11-18 y old) in the United States. The analysis was undertaken by pooling nationally representative samples obtained from the Nationwide Food Consumption Surveys of 1965 and 1977-1978 and the 1989-1991 Continuing Survey of Food Intakes by Individuals. Breakfast consumption, defined as the consumption of food, beverage, or both between 0500 and 1000, was the focus of the trends analysis. Descriptive results indicated a decline in breakfast consumption between 1965 and 1991, particularly for older adolescents aged 15-18 y; the rates for boys and girls declined from 89.7% and 84.4%, respectively, in 1965 to 74.9% and 64.7%, respectively, in 1991. Multivariate results indicated that breakfast consumption declined predominantly because of behavioral changes and not the population's changing sociodemographic patterns. The nutritional quality of foods consumed at breakfast has improved since 1965, with significant shifts toward consumption of lower-fat milk and smaller changes in other food groups. The improvement over time in the quality of food consumed at breakfast, however, is offset by the large percentage of persons aged > or = 11 y who do not presently consume breakfast. Given the association of obesity with less frequent breakfast consumption and the rise in obesity among persons of this age group, a renewed emphasis on the importance of breakfast is warranted.

Adolescent↗

PubMed1998

Dietary fat intake does affect obesity!

There is a difference of opinion about whether the percentage of dietary fat plays an important role in the rising prevalence of overweight and in its treatment once it has developed. We believe that ample research from animal and clinical studies, from controlled trials, and from epidemiologic and ecologic analyses provides strong evidence that dietary fat plays a role in the development and treatment of obesity. A reduction in fat intake reduces the gap between total energy intake and total energy expenditure and thus is an effective strategy for reducing the present epidemic of obesity worldwide. A review of the results from 28 clinical trials that studied the effects of a reduction in the amount of energy from fat in the diet showed that a reduction of 10% in the proportion of energy from fat was associated with a reduction in weight of 16 g/d. We thus conclude that dietary fat plays a role in the development of obesity. To reduce the prevalence of obesity, there must be an increase in energy expenditure, a reduction in total energy intake, or both. This goal can be facilitated by reducing the amount of fat in the diet.

Animals↗

PubMed1998

Adolescent obesity increases significantly in second and third generation U.S. immigrants: the National Longitudinal Study of Adolescent Health.

Little is known concerning obesity patterns of ethnic subpopulations in the U.S. and the effects of acculturation on these patterns. Adolescent obesity, a major public health problem, has important health, social and economic consequences for the adolescent. The National Longitudinal Study of Adolescent Health survey is unique in the size of the adolescent sample and in its ability to provide large representative samples of Anglo, African-American, Hispanic and Asian-American adolescents. A nationally representative sample of 13,783 adolescents was studied. Measurements of weight and height collected in the second wave of the survey were used to study adolescent obesity. Multivariate logit techniques were used to provide an understanding of the ethnic, age, gender and intergenerational patterns of adolescent obesity. Comparisons are presented between the NHANES III results and those from the Adolescent Health Survey. The smoothed version of the NHANES I 85th percentile cut-off was used for the measure of obesity in this paper. For the total sample, 26.5% were obese. The rates were as follows: white non-Hispanics, 24.2%; black non-Hispanics, 30.9%; all Hispanics, 30.4%; and all Asian-Americans, 20.6%. Important variations within the Hispanic and Asian-American subpopulations are presented. The Chinese (15.3%) and Filipino (18.5%) samples showed substantially lower obesity than non-Hispanic whites. All groups showed more obesity among males than among females, except for blacks (27.4% for males and 34.0% for females). Asian-American and Hispanic adolescents born in the U.S. are more than twice as likely to be obese as are first generation residents of the 50 states.

Acculturation↗

PubMed1998

The obesity epidemic is a worldwide phenomenon.

Obesity is not just a disease of developed nations. Obesity levels in some lower-income and transitional countries are as high as or higher than those reported for the United States and other developed countries, and those levels are increasing rapidly. Shifts in diet and activity are consistent with these changes, but little systematic work has been done to understand all the factors contributing to these high levels. The goal of this review is to provide an understanding of the patterns and trends of obesity around the world and some of the major forces affecting these trends. Several nationally representative and nationwide surveys are discussed.

Diet↗

PubMed1997

The nutrition transition: new trends in the global diet.

Analyses of economic and food availability data for 1962-1994 reveal a major shift in the structure of the global diet marked by an uncoupling of the classic relationship between incomes and fat intakes. Global availability of cheap vegetable oils and fats has resulted in greatly increased fat consumption among low-income nations. Consequently, the nutrition transition now occurs at lower levels of the gross national product than previously, and is accelerated further by high urbanization rates. Data from Asian nations, where diet structure is rapidly changing, suggest that diets higher in fats and sweeteners are also more diverse and more varied. Given that preferences for palatable diets are a universal human trait, fat consumption may be governed not by physiological mechanisms but by the amount of fat available in the food supply. Whereas economic development has led to improved food security and better health, adverse health effects of the nutrition transition include growing rates of childhood obesity. The implications of these trends are explored.

Diet↗

PubMed1996

A comparison of dietary trends among racial and socioeconomic groups in the United States.

BACKGROUND: There may be dietary differences among racial and socioeconomic groups in the United States. METHODS: Using data from a representative sample of adults, we compared dietary trends among blacks and whites of varying socioeconomic status. We developed comparable measures of diet and of the consumption of macronutrients and food groups for 6061 participants in the 1965 Nationwide Food Consumption Surveys, 16,425 in the 1977-1978 Nationwide Food Consumption Surveys, and 9920 in the 1989-1991 Continuing Survey of Food Intake by Individuals (all conducted by the U.S. Department of Agriculture). The primary outcome was the score (range, 0 to 16) on the Diet Quality Index, a composite of eight food-and-nutrient-based recommendations from the National Academy of Sciences. A score of 4 or less was considered to indicate a relatively more healthful diet, and a value of 10 or more a relatively less healthful diet. RESULTS: Overall dietary quality improved in all groups, from a mean Diet Quality Index score of 7.4 in 1965 to 6.4 in 1989-1991. In 1965, blacks of low socioeconomic status and, to a lesser extent, whites of low socioeconomic status had better diets than whites of high socioeconomic status. By the 1989-1991 survey, the differences among racial and socioeconomic groups had narrowed. In 1965, 9.3 percent of whites of low socioeconomic status, 16.4 percent of blacks of low socioeconomic status, and 4.7 percent of whites of high socioeconomic status had mean scores of 4 or less. In the 1989-1991 survey the respective percentages were 19.9, 23.5, and 20.0. Fat consumption decreased in all groups. The consumption of fruits and vegetables varied little over time, except for an increase among blacks of medium and high socioeconomic status. The consumption of grains and legumes increased over time among whites of medium and high socioeconomic status and declined among blacks of low socioeconomic status. CONCLUSIONS: In 1965, there were large differences among groups in dietary quality, with whites of high socioeconomic status eating the least healthful diet, as measured by the index, and blacks of low socioeconomic status the most healthful. By the 1989-1991 survey, the diets of all groups had improved and were relatively similar.

Adult↗

PubMed1996

Does women's work improve their nutrition: evidence from the urban Philippines.

Women's market work in developing countries is thought to improve their well-being directly through increased income for health-related purchases and indirectly through elevating women's status within the household. While a number of studies have looked at the effects of women's work and the cost of women's time on child nutrition and welfare, the direct effects of women's work on their own welfare have been largely untested. Using data on 1963 urban Filipino women from the Cebu Longitudinal Health and Nutrition Survey, we examined the relationship between women's work and their dietary intakes of energy, protein, fat, calcium, and iron from home and commercially prepared foods. Determinants equations for home and commercial intakes were estimated simultaneously to adjust for non-independence. Appropriate methods were used to deal with selectivity, endogeneity, and unobserved heterogeneity. Nearly half (48%) of the women worked for pay, and commercially prepared foods made up an important part of working women's diets. Not only did women's work improve the quality of their diets, but there were strong distributional implications; lower-income women gained more than higher-income women. Employment sector also influenced women's dietary patterns. Informal non-wage work was associated with increased intakes, whereas formal sector work was associated with decreased intakes. Positive effects of work in the informal sector were greater for women from low-income households. Policy implications of the dietary benefits of informal non-wage work for low-income women are discussed.

Adult↗

PubMed1996

Trends in breakfast consumption of US adults between 1965 and 1991.

OBJECTIVE: To examine breakfast consumption patterns and trends between 1965 and 1991 for adults in the United States. DESIGN: Trends analysis pooling three cross-sectional surveys. SETTING: Nationally representative samples obtained from the Nationwide Food Consumption Survey (NFCS) of 1965, the NFCS of 1977-1978, and the 1989-1991 Continuing Survey of Food Intakes by Individuals. SUBJECTS: Adults aged 18 years and older: 6,274 in 1965, 18,033 in 1977-1978, and 10,812 in 1989-1991. All results reflect use of sampling weights, so results reflect nationally representative samples in each time period. MAIN OUTCOME MEASURES: Breakfast consumption, defined as the consumption of food and/or beverage between the hours of 5 AM and 9 AM, was the focus of the trends analysis. Population prevalence rates are reported for the entire population and population subgroups. STATISTICAL ANALYSIS PERFORMED: Probit analysis was used to identify factors associated with changes in breakfast consumption over time. RESULTS: Breakfast consumption declined in the 26-year period between 1965 and 1991 from 86% to 75% for US adults. Breakfast consumption increased with age, and the age differential increased over time. Urban-rural and South-non-South differences in breakfast consumption narrowed over time, whereas black-nonblack and college-noncollege differences increased slightly or remained constant. The nutritional quality of food consumed at breakfast has improved since 1965. CONCLUSIONS: Although part of the decline in breakfast consumption can be explained by personal and demographic determinants, other unknown factors contributed to the trends. Elucidation of such factors is necessary to predict differences in breakfast as a health-related behavior.

Adolescent↗

PubMed1996

Low birth weight reduces the likelihood of breast-feeding among Filipino infants.

We studied the relationship of low birth weight (LBW) to concordance of mother's feeding intentions during pregnancy with actual feeding practices; initiation of breast-feeding; and patterns of feeding in the first 6 mo. Data came from the Cebu Longitudinal Health and Nutrition Survey, which followed 3080 mother-infant pairs from urban and rural communities of Metro Cebu, Philippines. We used logistic regression to estimate the effects of LBW on feeding practices, controlling for place of delivery (home, public or private health facility), receipt of free infant formula samples; infant sex, urban residence; primiparity, education level and age of the mother; and family income and assets. Birth of a LBW infant significantly decreased the likelihood that women would initiate breast-feeding. Of particular note is the finding of this decreased likelihood among women who during pregnancy had stated an intention to breast-feed. In a comparison of 6-mo feeding patterns, we also found that LBW increased the likelihood of not breast-feeding or of weaning before 6 mo. Among breast-feeding mothers, LBW increased the likelihood of full breast-feeding for 6 mo compared with patterns characterized by earlier supplementation with other foods and liquids. The negative relationship of LBW to breast-feeding was strongest when births took place in private or public health facilities. Given the known health risks of LBW and the proven benefits of breast-feeding, these results emphasize the need for special efforts to promote breast-feeding of LBW infants born in clinical settings.

Adult↗

PubMed1996

Stunting is associated with overweight in children of four nations that are undergoing the nutrition transition.

A higher risk of obesity in stunted children has been described in Hispanic-American, Jamaican and Andean populations, but little systematic exploration has been done concerning this area in nutrition. This paper examines the relationship between stunting and overweight status for children aged 3-6 and 7-9 y in nationally representative surveys in Russia, Brazil, and the Republic of South Africa and a large nationwide survey in China. Using identical cut-offs for body mass index, the prevalence of child overweight in these countries ranges from 10.5 to 25.6% (based on the 85th percentile); recent NHANES III results indicate that this prevalence is around 22% in the U.S. Stunting is also common in the surveyed countries affecting 9.2-30.6% of all children. Our results showed a significant association between stunting and overweight status in children of all countries. The income-adjusted risk ratios of being overweight for a stunted child ranged from 1.7 to 7.8. Clearly, there is an important association between stunting and high weight-for-height in a variety of ethnic environmental and social backgrounds. Although the underlying mechanisms remain unexplored, this association has serious public health implications particularly for lower income countries. As these countries enter the nutrition transition experiencing large changes in dietary and activity patterns, they may face, among other problems, additional difficulties in their fight against obesity.

Body Mass Index↗

PubMed1996

The nutritional status of the elderly in Russia, 1992 through 1994.

OBJECTIVES: The purpose of this study was to ascertain how economic reform has affected nutritional well-being of the elderly in the Russian Federation. METHODS: A sample of more than 2932 Russians 60 years of age and older was selected from a nationally representative survey of Russian households. A 24-hour dietary recall and data on weight, height, and socioeconomic status were collected during 1992 and 1993 and from a separate nationally representative sample of 1955 persons in the same age group in 1994. RESULTS: Russia's elderly did not experience major declines in economic or nutritional well-being during the first 2 years of the reform period. Dietary composition shifted slightly toward reduced fat consumption. A small proportion of individuals showed signs of underweight. Of those who were underweight in 1992, none had lost more than 3 kg of weight by 1993. Among those 70 years of age and older, none who were underweight had lost any appreciable weight, although half lost small amounts. CONCLUSIONS: Many more underweight elderly people increased than reduced their weight. Mean weight increased among all body mass index groups over the year reported here. However, economic conditions in December 1994 raise concerns.

Aged↗

PubMed1996

Longitudinal analysis of the effects of infant-feeding practices on postpartum amenorrhea.

The Cebu Longitudinal Health and Nutrition Survey is used to examine the effect of various components of infant-feeding patterns on return of menses postpartum. The results show that factors such as active suckling, the use of two breasts versus one, breast-feeding on demand versus on a fixed schedule, and the feeding of other milks and of nonnutritive or low-caloric other liquids can be important under selected circumstances. Discrete-time logistic hazards modeling is used to estimate the weekly probability of return to menses.

Amenorrhea↗

PubMed1995

Dietary and environmental correlates of obesity in a population study in China.

The patterns and correlates of obesity in China were studied in two panels of a nationwide longitudinal survey conducted in 1989 and 1991 (the China Health and Nutrition Survey). Among the Chinese adults, dietary energy and fat intakes were positively and significantly associated with the Body Mass Index (BMI). Household income and physical activity level were also significantly associated with BMI. Urban residence and higher income were associated with lower energy intake, higher fat intake, and lower physical activity level compared to rural residence and other income categories. This paper documents an important emerging health problem: the increasing problem of obesity that has been observed in many lower-income countries during the last several decades.

Adult↗

PubMed1995

A review of dietary and environmental correlates of obesity with emphasis on developing countries.

The relationships between dietary and environmental factors and obesity are reviewed. Findings from selected population studies of diet and body weight are presented. In general, the results from population studies of diet and obesity have been inconsistent and marked with methodological weaknesses, especially the use of cross-sectional study design. Apart from the diet, several social and economic factors appear to be important correlates of obesity in the population. However, most studies have focused on the socioeconomic status as a broad, composite measure. The relationships between income, education, occupation, place of residence, and obesity are reviewed here, with emphasis on the developing countries. In many developing countries, the changing dietary pattern, along with rising life expectancy and changing socioeconomic environment, has contributed to the increasing problems of obesity and other diet-related chronic diseases that will have an enormous impact on the health and health care resource of these countries in the near future.

Body Weight↗

PubMed1995

Body weight patterns among the Chinese: results from the 1989 and 1991 China Health and Nutrition Surveys.

OBJECTIVES: A longitudinal survey assessed the distribution of adult body weight among the Chinese population. METHODS: Data from the 1989 and 1991 China Health and Nutrition Survey were used to study changes in the proportions of adults aged 20-45 years who were classified as underweight, normal weight, overweight, and severely overweight. RESULTS: There was a slight decline in the proportion of men and women classified as underweight, but among lower-income persons an increase occurred. The proportion of adults with normal body weight decreased, and the proportions of those classified as overweight and severely overweight increased during the same period. The observed increases in proportions of adults classified as overweight and severely overweight were largely confined to the urban residents and to those in the middle- and high-income groups. CONCLUSIONS: Results indicate increases in both obesity and undernutrition. Current efforts in China to develop a preventive health care policy emphasize the prevention of excess nutrient intakes and overnutrition and, hence, address the problem of the increase in obesity among well-to-do, mostly urban residents. However, the increase in undernutrition among low-income Chinese adults should not be overlooked and requires further research and serious policy consideration.

Adult↗