Nutrient adequacy of diets of adults with hypercholesterolemia after a cholesterol-lowering intervention: long-term assessment.
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Adult↗
Biomedical subjects
B M Shannon
Publications and source records attributed to B M Shannon.
Psychosocial factors in nutrition education for hypercholesterolemic children.
The goals were to assess psychosocial effects of labeling children as hypercholesterolemic and to measure changes in child well-being as a function of participation in nutrition education interventions. Older (6-10 years old) and younger (4-6 years old) children with (> 4.55 mmol/l; > 176 mg/dL) and without elevated total cholesterol levels were identified by cholesterol screening. Psychosocial functioning (self-esteem, perceived dietary competence, health beliefs, parental control of eating) was assessed and at-risk children were randomized into a home-based, self-contained nutrition education program (the Parent-Child Autotutorial, or PCAT program), dietary counseling with a registered dietician, or an at-risk control group. At three, six, and twelve months following baseline, children's psychosocial functioning again was assessed; parents also provided data at baseline, three months, and twelve months. Analyses of data from 189 at-risk and 74 not-at-risk children revealed that: (a) Older hypercholesterolemic children reported poorer health beliefs than non-labeled children; (b) Older girls in nutrition education programs reported lower self-esteem than control group girls; (c) Older children's feelings of efficacy at choosing a healthful diet were positively related to their health beliefs and self-esteem; (d) Younger children's reports of parents' dietary control were negatively related to children's feelings of acceptance; and (e) Parents of older children in the PCAT program reported increases over time in children's ability to choose a healthful diet. The quasi-experimental design means that conclusions about negative labeling effects should be drawn cautiously, but the evidence suggests that education interventions can have an impact on child efficacy and potentially child adjustment. Factors associated with adverse reactions to labeling (parental control or feelings of efficacy) should be taken into account in the development of intervention programs for children.
Adolescent↗
Age-related changes in cardiovascular disease risk factors of hypercholesterolemic children.
OBJECTIVE: To describe the age-related changes in cardiovascular disease risk factors in young, hypercholesterolemic (HC) children. METHODS: Hypercholesterolemic (n = 227) and nonhypercholesterolemic (NHC) (n = 80) children between the ages of 4 and 10 years were identified. Height, weight, skin-fold and blood pressure measurements, and total cholesterol levels were measured. The HC group also had insulin levels evaluated. The groups were compared by analysis of variance. Simple Spearman correlations evaluated the associations between factors within each group. RESULTS: The HC and NHC groups had similar mean ages, heights, and weights, both contained 51% girls, and all were white subjects. Percent weight-for-height median, and biceps, triceps, suprailiac and subscapular skin-fold measurements were all larger for the HC group. A significant age interaction demonstrated that the HC group's larger suprailiac and sum of skin-fold measures were expressed in the 8.0- to 9.9-year-old children, but not the 4.0- to 5.9-year-olds. For both groups, systolic blood pressure was associated with the measures of adiposity. For the HC group, insulin levels were also associated with adiposity. CONCLUSIONS: These results suggest that: (1) children with HC have greater body fat, (2) the expression of the hypercholesterolemia precedes the expression of increased body fat, (3) body fat increases with age, and (4) altered insulin and blood pressure levels are expressed in association with the increased body fat in children with HC. Confirmation with longitudinal data is necessary.
Adipose Tissue↗
Growth of hypercholesterolemic children completing physician-initiated low-fat dietary intervention.
OBJECTIVE: To evaluate the growth of hypercholesterolemic children completing an innovative, physician-initiated, home-based nutrition education program or standard nutrition counseling that aims to lower dietary fat intake. STUDY DESIGN: From suburban pediatric practices, 261 3.9- to 9.9-year-old children with elevated cholesterol levels and 81 children with nonelevated cholesterol levels were identified. The children with hypercholesterolemia were randomly assigned to the home-based education program, standard nutrition counseling, or an at-risk control group. Height, weight, skinfold measures, and dietary intake were evaluated at baseline, 3, 6, and 12 months; changes in anthropometric measures among treatment groups were compared over time. RESULTS: The intervention groups demonstrated significant decreases in fat and saturated fat intake after the interventions; however, weight z-score, height z-weight-for-height-median, and sum of skinfolds did not vary among the treatment groups over the year. At baseline, height z-score, weight z-score, and weight-for-height-median were positively associated with caloric intake, whereas weight z-score, weight-for-height-median, and sum of skinfolds were positively associated with fat intake. When the groups were combined and the children were grouped by average fat intake quintiles, no association between fat intake and changes in weight z-score, height z-score, or weight-for-height-media was observed. Differences over time in sum of skinfolds among fat intake quintile groups (suggesting a negative association between fat intake and body fat) that approached statistical significance (p = 0.06) were observed. CONCLUSIONS: These results support the safety, with respect to growth, of physician-initiated dietary intervention and lower fat diets for children with hypercholesterolemia. In addition, low dietary fat intake was associated with lower body fat.
Body Height↗
One-year follow-up of nutrition education for hypercholesterolemic children.
OBJECTIVES: This study evaluated retention of the effect of a home-based, practitioner-initiated nutrition education model. METHODS: Children with elevated low-density lipoprotein (LDL) cholesterol levels were randomly assigned to one of two nutrition interventions or to an at-risk control group. Intervention effects were evaluated 3, 6, and 12 months postbaseline. RESULTS: The parent-child autotutorial group demonstrated significant increases in knowledge and, along with the counseling group, decreases in total and saturated fat intake. Also, the autotutorial and counseling groups retained a majority of their initial LDL cholesterol decrease. CONCLUSIONS: Knowledge of heart-healthful eating and dietary fat intake as well as dietary change can be affected and retained via home-based, practitioner-initiated nutrition interventions with hypercholesterolemic children, although some form of ongoing intervention may be necessary to produce lasting decreases in LDL cholesterol levels.
Adult↗
Effects of family history of heart disease, apolipoprotein E phenotype, and lipoprotein(a) on the response of children's plasma lipids to change in dietary lipids.
We examined the effects of family history of coronary artery disease (CAD), apolipoprotein E (apo E) phenotype, and lipoprotein(a) [Lp(a)] on the response of plasma lipids to change in dietary lipid intake after 3 mo of nutrition education in 125 children aged 4-10 y. The subjects were healthy children with elevated low-density-lipoprotein (LDL)-cholesterol concentrations who participated in the Children's Health Project, a nutrition-education program designed to lower plasma cholesterol by means of dietary modifications in accordance with recommendations of the National Cholesterol Education Program. Dietary and plasma lipids were measured by three 24-h recalls and assessments of two fasting plasma samples collected before and 3 mo after the start of intervention. Family history of CAD was determined by questionnaires administered to parents at baseline. Apo E phenotyping was done with isoelectric focusing followed by immunostaining; Lp(a) was measured with two-site immunoradiometric assays of frozen aliquots of plasma samples collected at baseline and 3 mo. After adjustment for intervention group, age, sex, and body mass index, analysis of covariance showed that baseline plasma lipid concentrations were the strongest independent predictors of change in plasma lipids after 3 mo. Plasma total and LDL-cholesterol concentrations in children with less family history of CAD were significantly more responsive to change in dietary cholesterol than concentrations in children with a stronger family history of CAD. Neither apo E phenotype nor Lp(a) significantly influenced change in plasma lipids independently or interactively with change in dietary lipids.
Apolipoproteins E↗
The effect of changes in dietary fat on the food group and nutrient intake of 4- to 10-year-old children.
OBJECTIVE: To determine how young children changed their overall diet when they changed their fat intake after 3 months of participating in a nutrition education demonstration study designed to lower low-density lipoprotein cholesterol and cardiovascular risk. METHODS: Three 24-hour dietary recalls were collected from 303 4- to 10-year-old children at baseline and 3 months later. At both times, mean number of servings from food groups, grams of fat contributed from food groups, and intake of calories and nutrients were calculated and compared among quartiles of children formed according to change in their percent of calories from total fat after 3 months. RESULTS: Children who reduced their percent of calories from total fat most (ie, by an average of 8.5%) after 3 months consumed fewer servings from meats, eggs, dairy, fats/oils, and breads but tended to increase their number of servings from lower-fat foods within those food groups, particularly from dairy foods. These children also increased their mean intake of fruits, vegetables, and desserts, and maintained average intakes of all nutrients (except vitamin D) in excess of two thirds of the respective recommended dietary allowance. CONCLUSIONS: Young children who reduced their percent of calories from total fat in accordance with the current National Cholesterol Education Program recommendations accomplished this by reducing their overall intake of higher-fat foods, replacing higher-fat foods with lower-fat foods within several food groups, particularly within the dairy group (eg, drinking skim milk instead of whole milk) and by consuming more servings of fruits, vegetables, and very-low-fat desserts. These behaviors did not compromise their mean calorie or nutrient intakes, showing that it is possible for young children to lower their fat intake safely to reduce their risk of future heart disease.
Child↗
The cost-effectiveness of alternative methods of nutrition education for hypercholesterolemic children.
OBJECTIVES: This study compared the cost-effectiveness, from the family's perspective, of a parent-child auto-tutorial nutrition education program with that of counseling by a dietitian after identification of hypercholesterolemic children in pediatric offices. METHODS: Personnel, parent time, equipment, and laboratory costs associated with the interventions were analyzed. Reductions in dietary fat as a percentage of total calories were analyzed by means of 24-hour dietary recalls and in plasma low-density lipoprotein cholesterol at 3 and 12 months postintervention. RESULTS: Average costs totaled $208.08 for the parent-child auto-tutorial program and $213.28 for counseling. While the parent-child program was somewhat less cost-effective in terms of dietary change, it was more cost-effective in terms of lipid reduction at 3 months, although this advantage disappeared by 12 months. CONCLUSIONS: Modest reductions in fat in the diet and in plasma lipid levels were achieved at costs that also appear modest in comparison with treatment of elevated cholesterol in adulthood. Follow-up interventions may be needed to sustain effects, while longitudinal studies are needed to assess the long-term cost benefit.
Adolescent↗
Influences on adolescent eating behavior.
PURPOSE: The food consumption behavior of American adolescents often fails to meet dietary recommendations, indicating the need for investigation of the factors that influence this behavior. This study, guided by Bandura's Social Cognitive Theory, examined relationships between such behavior and other personal, environmental, and behavioral variables. METHODS: A paper-and-pencil instrument was administered to a sample of 242 high school students. "Pyramid," fat, and sugar food scores were calculated to measure subjects' dietary diversity along with their consumption of fats and sugar/sweets. Statistical analyses were conducted to identify relationships between subjects' food scores and other study variables. RESULTS: Male and female subjects' pyramid scores were positively related (p < or = 0.05) to the number of meals they consumed daily. Some gender differences emerged in the data, as conformity to parents, snack consumption, and consumption of meals and snacks from home predicted males' Pyramid scores, while amount of physical exercise predicted pyramid scores of females. Both male and female subjects' fat and sugar scores were positively related (p < or = 0.05) to their consumption of meals and snacks from the school cafeteria and overall snack consumption and negatively related to their self-efficacy for making healthful food choices. Females' fat scores were further predicted by their consumption of fast food. CONCLUSIONS: Different aspects of adolescents' food consumption behavior may be influenced by different factors, which may vary between males and females. Therefore, nutrition and health professionals should tailor educational and treatment strategies according to both the gender of their patients and the specific desired dietary outcomes.
Adolescent↗
The dietary intake of children with IDDM.
OBJECTIVE: To assess the dietary intake of children with IDDM and to determine whether the intake meets the current nutritional recommendations for children with IDDM. RESEARCH DESIGN AND METHODS: A total of 66 children with IDDM who were < 10 years of age were recruited from two suburban Pennsylvania hospitals. To collect dietary intake data, subjects were asked, via telephone interview, to complete three random-day 24-h dietary recalls. Data were analyzed for the content of nutrients and other food components by a computerized database program. Intakes were expressed as a 3-day average intake for each subject. RESULTS: Overall mean intake of protein and cholesterol approximated the current recommendations. The mean intake of saturated fat exceeded recommendations, while fiber intake was less than the recommended level. Many of the children consumed levels of saturated fat well above recommendations. Energy, vitamin, and mineral intakes were adequate for the overall sample. However, from 10 to 40% of the sample had an inadequate intake of vitamin D, vitamin E, and zinc. The percentage of those with inadequate intakes of these nutrients decreased with age. CONCLUSIONS: These data suggest that, on average, among this sample of children with IDDM aged < 10 years, adherence to the current nutritional recommendations for children with IDDM was adequate, but some individual children had intakes that were not consistent with the recommendations for optimal management of IDDM.
Child↗
The cost of implementation of the Clinical Laboratory Improvement Amendments of 1988--the example of pediatric office-based cholesterol screening.
OBJECTIVE: To measure the additional costs of office-based laboratory testing due to the implementation of the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88), using cholesterol screening for children as an example. METHODS: Four- to ten-year-old children who received their well child care at one of seven participating pediatric practices were screened for hypercholesterolemia. The average number of analyses per day and days per month were derived from the volume of testing completed by the practices. Nurses and technicians time in the screening process were measured and personnel costs were calculated based on salary and fringe benefit rates. Costs of supplies, analyzing control samples, instrument calibration, and instrument depreciation were included. Costs estimates of screening were then completed. CLIA '88 implementation costs were derived from appropriate proficiency testing and laboratory inspection programs. RESULTS: In six practices completing a low volume of testing, 2807 children (5 to 6 children per week) were screened during the observation period, while 414 (about 25 children per week) were screened in one high-volume practice implementing universal screening over a 4-month period. For the six low-volume practices, the cost of screening was $10.60 per child. This decreased to $5.47 for the high-volume practice. Estimated costs of CLIA '88 implementation, including additional proficiency testing and laboratory inspection, added $3.20 per test for the low-volume practices, and $0.71 per test for the high-volume testing. CONCLUSIONS: Implementation of CLIA adds significantly to the cost of office-based chemistry laboratory screening. Despite these additional expenses, the cost of testing is still within a reasonable charge for laboratory testing, and is highly sensitive to the volume of tests completed.
Calibration↗
Reduction of elevated LDL-cholesterol levels of 4- to 10-year-old children through home-based dietary education.
OBJECTIVE: To assess the effects of a home-based, parent-child autotutorial (PCAT) dietary education program on the dietary knowledge, lipid consumption, and plasma low density lipoprotein-cholesterol (LDL-C) of 4- to 10-year-old children with elevated plasma LDL-C. METHODS: "At-risk" children (screening total cholesterol, (TC), exceeded 4.55 mmol/L and average LDL-C from two fasting samples was between 2.77 and 4.24 mmol/L for boys or 2.90 and 4.24 mmol/L for girls) were randomized to the PCAT program (N = 88), for dietary counseling with a registered dietitian (N = 86), or to an at-risk control group (N = 87). Dietary knowledge, diet, and LDL-C of these groups were assessed at baseline and after the educational period (3-month follow-up). The knowledge and diet of a not-at-risk (TC below 4.22 and 4.34 mmol/L for boys and girls, respectively) control group (N = 81) was also assessed and compared with that of the at-risk control group. RESULTS: At the 3-month follow-up, the PCAT children's knowledge scores had increased three times more than those of the counseling and at-risk control groups (P < .001). Mean grams of total and saturated fat consumed by PCAT and counseling groups declined while that of the at-risk control group increased slightly; these differences were significant (P < .05). The mean LDL-C decline of the PCAT group was significantly different (P < .05) from the decline of the at-risk control group (0.26 vs 0.09 mmol/L), and approached significance (P = .07) when compared with that of the counseling group (0.26 vs 0.11 mmol/L). The at-risk control group's knowledge and diet did not differ from that of the not-at-risk group. CONCLUSION: The PCAT program offers a mechanism for providing effective dietary education to children with elevated cholesterol and to their families.
Child↗
A quality assurance program for the measurement of capillary blood cholesterol levels in private pediatric practices. The Children's Health Project.
OBJECTIVE: To develop an easy to use quality assurance program for the measurement of capillary blood cholesterol levels in private pediatric practices. The program needed to comply with the guidelines laid down by the National Cholesterol Education Program. DESIGN: Intervention study. SETTING: Nine private pediatric practices in and around northern Philadelphia, Pa. PARTICIPANTS: The analysts included clinic staff members with laboratory expertise ranging from none to some previous experience. None of the participants had previous experience with a quality assurance program. INTERVENTIONS: Progress was reported monthly to the Lipid Research Laboratory, Philadelphia, and action was taken to correct inaccuracies in bias or variance. MAIN OUTCOME MEASURE: Compliance with the analytical guidelines laid down by the National Cholesterol Education Program in that the coefficient of variation was no greater than 5% and the bias was no greater than +/- 5% in the first year of the study. RESULTS: Within the first year of the study, there were 152 monthly quality assurance returns for each of two lyophilized control materials. On four occasions the coefficient of variation was greater than 5% while the overall bias was within the desired +/- 5% on 143 (94%) of 152 occasions. After the first 3 months of the study, as user confidence increased, intervention by the Lipid Research Laboratory became minimal. The internal quality assurance was further evaluated by a successful performance in a quarterly external quality assurance program. CONCLUSIONS: It is possible to devise an easy to use quality assurance program for extra laboratory measurement of cholesterol levels in children, and, with minimal assistance, maintain acceptable standards of cholesterol analysis. The quality assurance improved following the first 3 months of training and education. Subsequent continuous quality improvement was maintained with minimal involvement of the specialist center. Should the controversial issue of private office measurement of blood cholesterol levels become universally acceptable, the implication from our study is that standards acceptable to the National Cholesterol Education Program and the Clinical Laboratory Improvement Amendments of 1988 are possible using a suitable quality assurance program.
Bias↗
Time and cost analysis of a computer-assisted telephone interview system to collect dietary recalls.
This study, conducted in 1991, examined the time requirements and costs of obtaining 24-hour dietary recalls via telephone interviews using the University of Minnesota's microcomputer Nutrient Data System to conduct the interviews and compute the nutrient composition of the diets. The subjects were 156 hypercholesterolemic children (aged 4-10 years) and 102 hypercholesterolemic adults (aged 21-65 years), who were participating in ongoing cholesterol education programs. A total of 391 recalls were completed with the children and 278 with the adults. For each completed interview, 3.5 and 2.8 attempts were required, respectively. Evenings were the most productive time for completing interviews. All tasks associated with completing the interviews (attempts to call, interviews per se, and postinterview procedures) required an average of 39.7 and 35.5 minutes per completed interview with the children and adults, respectively. About half of these total times were actually devoted to conducting the interview. The costs per completed interview were $9.22 for the children versus $6.99 for the adults. This difference reflects the greater number of attempts required to reach the children, the longer duration of their interviews, and the higher intrastate toll rates for calls to them as compared with the interstate rates for calls to the adults.
Adult↗
Role of food and nutrition in the health perceptions of young children.
Sixty healthy children, 4 to 7 years of age, were interviewed to evaluate their health perceptions in general and to determine the degree to which they included food and eating behavior in their perceptions. Individual interviews with children incorporated both closed-ended and open-ended questions. Concept maps were used to analyze interview transcripts. The pretest/posttest experimental design randomly assigned children to experimental and control groups. Children in the experimental group completed a 4-week, home-based, nutrition education program to determine the feasibility of changing children's health perceptions with an educational intervention. Pretest and posttest health perception scores were compared by analysis of covariance. Results indicated that children perceived nutrition as a meaningful concept in relation to their health perceptions at pretest, but that after program participation, children significantly increased their perception that health and nutrition were related concepts. Our findings indicate that young children are cognitively ready to learn more about food, nutrition, and health than previously thought, but closed-ended questions may not be sensitive enough to evaluate their learning at this age.
Attitude to Health↗
A peer educator approach to nutrition for the elderly.
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Aged↗
Fast foods: a perspective on their nutritional impact.
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Adolescent↗
Cystathionine excretion in relation to vitamin B-6 nutriture of rats: strain differences and effects of DL- or L-methionine supplementation.
Wistar and Long-Evans rats excreted significantly more cystathionine during days 27 to 31 of a vitamin B-6 deficiency than did Spague-Dawley rats. Wistar rats were therefore chosen for experiments designed to test the effects of dietary DL- and L-methionine supplementation upon cystathionine excretion of vitamin B-6-deficient and control rats. Methionine supplementation did not significantly affect mean daily food consumption or weight gain of the control animals. L-Methionine-supplemented, deficient rats gained significantly more during the first 15 days of the experiment and less during the last 11 days than did the other deficient groups. No cystathionine was detected in the urine of methionine-supplemented or unsupplemented control rats between days 8 and 26 of the experiment; but measurable quantities of cystathionine were present in the urine of all deficient groups by days 8 to 12. Deficient animals fed DL-methionine excreted up to 2.33 mg more cystahionine per 4-day period than did the unsupplemented deficient rats, whereas rats fed L-methionine excreted up to 7.44 mg more per 4-day period than did the unsupplemented ones. This difference in cystathionine response was highly significant and indicates that the L supplement stressed the vitamin B-6-deficient rats more than did the DL supplement. An explanation for this may be that the D isomer in the DL supplement was not as efficiently absorbed and/or metabolized as the L form.
Animals↗