PubMed Health⌕ Search

Biomedical subjects

H Smiciklas-Wright

Publications and source records attributed to H Smiciklas-Wright.

At least 19 recordsLinked to original sources
PubMed2001

Screening for hospitalization and nutritional risks among community-dwelling older persons.

BACKGROUND: The potential for the use of nutritional screening to identify older persons at risk of hospitalization has not been contrasted with the use of tools developed for predicting hospital admissions. OBJECTIVE: Our goal was to compare the associations of items from the Level II Nutrition Screen (LII) and the Probability of Repeated Admissions (P(ra)) questionnaire with the outcome of hospitalization. DESIGN: This was a cohort study of participants in a Medicare managed-risk health plan who completed both the LII and P(ra) (n = 386). All hospitalizations within 1 y of screening were recorded. Hierarchical multivariate logistic regression was used to model associations with hospitalization. RESULTS: P(ra) items that retained significant associations with hospitalization were self-reported health, hospitalization in the past year, and >6 doctor visits in the past year (positive predictive value: 20%; sensitivity: 53.1; specificity: 69.7). LII items that retained significant associations with hospitalization were eating problems and polypharmacy (positive predictive value: 17.9%; sensitivity: 58.0; specificity: 56.3). Those persons designated by the P(ra) score as being at high risk of hospitalization (P(ra) > or = 0.30, 75th percentile) were also more likely to report weight loss, polypharmacy, consumption of a special diet, and functional limitation on the LII. CONCLUSIONS: Retained items from the P(ra) and the LII were comparable in identifying participants at risk of hospitalization. These observations suggest that nutritional risk factors such as eating problems, weight loss, and consumption of special diets should be considered in the management of older persons at risk of hospitalization, irrespective of the screening approach selected.

Aged↗
PubMed2001

Maternal milk consumption predicts the tradeoff between milk and soft drinks in young girls' diets.

Milk intake constitutes an important source of dietary calcium for young girls but declines throughout childhood. Recent work shows that the intake of soft drinks may contribute to this decline. Influences on the apparent tradeoff between soft drinks and milk in young girls' diets are not well described. The objective of this research was to test a model depicting maternal beverage choices as predictors of their daughters' milk and soft drink intake. A structural equation model describing maternal influences on daughters' milk, soft drink and calcium intakes was tested using data from 180 non-Hispanic, white families with 5-y-old daughters. Mothers' calcium, milk and soft drink intakes were evaluated as predictors of their daughters' intakes. Mothers' and daughters' soft drink intakes were also examined as predictors of their own milk and calcium intakes. The model provided a good fit to the data, revealing mother-daughter similarities in beverage intake. Mothers who drank milk more frequently had daughters who drank milk more frequently and drank fewer soft drinks. For both mothers and daughters, soft drink consumption was negatively related to both milk and calcium intake. This research provides evidence that mothers' beverage choices influence the tradeoff between milk and soft drinks in their daughters' diets. In particular, mothers' milk and soft drink intakes may affect their daughters' calcium adequacy in early childhood by influencing the frequency with which their daughters consume those beverages.

Adult↗
PubMed2001

Diet quality, nutrient intake, weight status, and feeding environments of girls meeting or exceeding recommendations for total dietary fat of the American Academy of Pediatrics.

OBJECTIVES: To compare the diet quality and weight status of girls consuming diets meeting the recommendation of the American Academy of Pediatrics for dietary fat with those of girls consuming >30% of energy from fat and to examine relationships between girls' dietary fat intake, mothers' nutrient intakes, and mothers' child-feeding practices. DESIGN: Participants were 192 white girls and their mothers, who were divided into 2 groups: >30% of energy from fat (high fat [HF]) or </=30% of energy from fat (low fat [LF]), based on girls' 3-day dietary recalls. Girls' food group and nutrient intakes, Healthy Eating Index, body mass index, and mothers' nutrient intakes and child-feeding practices were compared. RESULTS: Girls with HF diets consumed fewer fruits, more meat, and more fats and sweets and had lower Healthy Eating Index scores than did the girls in the LF group. Mothers of girls in the HF group had higher fat intakes than did those in the LF group. Girls and mothers in the HF group had lower intakes of fiber and vitamins A, C, B6, folate, and riboflavin. Mothers in the HF group reported using more restriction and pressure to eat in feeding their daughters. Girls in the HF group showed greater increase in body mass index and skinfold thickness from age 5 to 7 years. CONCLUSION: These findings provide additional support for the recommendation of the American Academy of Pediatrics to limit total dietary fat. Findings reveal that mothers' use of controlling feeding practices are not effective in fostering healthier diets among girls and that mothers' own eating may be more influential than their attempts to control the intake of their daughters. dietary fat, dietary quality, nutrient intake, overweight, feeding practices, children.

Academies and Institutes↗
PubMed2000

Accuracy of energy intake data estimated by a multiple-pass, 24-hour dietary recall technique.

OBJECTIVE: This study examined the accuracy of a multiple-pass, 24-hour dietary recall method for estimating energy intakes of men and women by comparing it with energy intake required for weight maintenance. DESIGN: Three-day, multiple-pass, 24-hour recalls were obtained on randomly selected days during a self-selected diet period when subjects were preparing their own meals and during a controlled diet period when all meals were provided by the study. During the dietary intervention, weight was maintained; body weight and dietary intake were monitored closely, thereby allowing estimation of the energy intake required for weight maintenance. SUBJECTS/SETTING: Seventy-eight men and women (22 to 67 years old) from the Dietary Effects on Lipoprotein and Thrombogenic Activity (DELTA) study participated in this study. All 24-hour recalls were collected using a computer-assisted, interactive, multiple-pass telephone interview technique. Energy requirements for each individual were determined by the energy content of the DELTA study foods provided to maintain weight. STATISTICAL ANALYSIS: Paired and independent t tests were conducted to examine differences among study variables. Agreement between recalled energy intake and weight maintenance energy intake was analyzed using the Bland-Altman technique. RESULTS: Compared with weight maintenance energy intake, during the self-selected diet period men and women underestimated energy intake by 11% and 13%, respectively. During the controlled diet period, men underestimated energy intake by 13%, whereas women overestimated energy by 1.3%. APPLICATIONS/CONCLUSIONS: Men had a tendency to under-estimate energy intake irrespective of the recording period. The accuracy of the recalled energy intake of women may be influenced by recording circumstances. Researchers should examine the factors influencing underreporting and overreporting by individuals and their impact on macronutrient and micronutrient intakes. Also, strategies need to be developed to minimize underreporting and overreporting.

Adult↗
PubMed2000

Breast-feeding through the first year predicts maternal control in feeding and subsequent toddler energy intakes.

OBJECTIVE: Current recommendations for infant feeding encourage breast-feeding through the first year. This research was conducted to evaluate associations among breast-feeding, maternal control of child feeding, and the dietary intake of toddlers during the second year of life. In particular, we sought to determine whether breast-feeding through the first year and subsequent toddler intake was mediated via maternal control of child feeding. DESIGN/SUBJECTS: Fifty-five white infants and their mothers were monitored longitudinally from age 12 or 13 months to age 18 months. MAIN OUTCOME MEASURES: Breast-feeding through the first year and maternal control in infant feeding were evaluated as predictors of energy intake at age 18 months. STATISTICAL ANALYSES PERFORMED: Regression analysis was used to evaluate predictors of toddler energy intake at age 18 months. A mediation model tested if the relationship between breast-feeding and infant intake was mediated by maternal control in feeding. RESULTS: Breast-feeding through the first year was associated with higher toddler energy intakes at age 18 months through its influence on maternal control in feeding. Mothers who breast-fed their infants for at least 12 months used lower levels of control in feeding. Lower levels of maternal control in feeding were associated with higher toddler energy intakes. The highest energy intakes among children aged 18 months were observed among taller and leaner toddlers. APPLICATIONS/CONCLUSIONS: Our findings suggest that breast-feeding through the first year may have an effect on children's energy intake by shaping mothers' child-feeding practices. These findings may be used by clinicians to assist parents in making informed decisions about choice of infant-feeding method and to provide anticipatory guidance regarding infant-feeding style when initiating dietary diversity.

Adult↗
PubMed2000

Responses of older adults to theory-based nutrition newsletters.

OBJECTIVE: To evaluate the effect of a theory-based newsletter on knowledge, attitude, and behavior change in older adults. DESIGN: Pretest-posttest, random assignment, and treatment-control design with 2 treatment groups: 1 that received newsletters only and 1 that received newsletters with follow-up telephone interviews. Control group completed pretest-posttest surveys only. SUBJECTS/SETTING: Four hundred eighty men and women, aged 60 to 74 years, were recruited to participate in a home-based educational intervention using a patient list generated from a rural tertiary care hospital database, Geisinger Medical Center in Danville, Pa. INTERVENTION: Five nutrition newsletters designed using the nutrition communication model and adult learning theory principles were mailed biweekly. Telephone interviews followed each of the 5 newsletters 10 to 14 days after distribution. OUTCOME MEASURES: Nutrition knowledge and interest, food behavior related to dietary fat, and stages of change for dietary fat and fiber. STATISTICAL ANALYSES PERFORMED: Analysis of covariance was used to determine group differences in posttest outcome measures using pretest as covariate. RESULTS: In addition to achieving higher scores than the control group, the treatment groups were significantly different from each other in correct and perceived nutrition knowledge at posttest. Those in the treatment group receiving telephone calls scored higher (mean change = 19.0% for correct and 20.3% for perceived) than those who received the newsletters only (mean change = 12.5% for correct and 14.3% for perceived; P < .05). Treatment groups also rated their interest in nutrition higher than the control group did; there was no between-treatment difference. Treatment groups performed significantly better than the control group for dietary fiber stage of change (P < .05). Those receiving only newsletters scored significantly better than the control for the "avoid fat" food behavior (P < .05). APPLICATIONS/CONCLUSIONS: This study provides an example of the incorporation of a theoretical model in development and evaluation of newsletters. Home-delivered nutrition newsletters based on this model can communicate health and nutrition information to older adults. Consumers today have more opportunities than ever before to access nutrition information quickly and inexpensively. Newsletters can help dietetics professionals filter and limit what consumers must process, saving clients time and improving the accuracy of information obtained. Dietetics professionals in both clinical and community practice are uniquely positioned to provide highly focused and understandable information to consumers via a newsletter format.

Aged↗
PubMed2000

Designing a quality assurance system for dietary data in a multicenter clinical trial: Women's Intervention Nutrition Study.

Reliable dietary intake data are essential for determining outcomes in nutrition-related clinical trials. Nevertheless, systems for quality assurance of dietary intake data are often slighted in the design of such trials and not incorporated or monitored as the trials continue. The Women's Intervention Nutrition Study (WINS), a multicenter clinical trial investigating the effect of reduction of dietary fat intake together with adjuvant systemic therapy on recurrence rates in and survival of postmenopausal women with early stage, surgically treated, breast cancer, has developed a quality assurance system to minimize errors and to produce data that are complete and reliable. The system involves development of standardized procedures for data collection, a quality control program to evaluate the data collected, and continual monitoring and reevaluation. The WINS system is offered as a model for studies collecting dietary intake data, no matter how simple or complex the trial design.

Clinical Trials as Topic↗
PubMed2000

Nutritional guidance is needed during dietary transition in early childhood.

OBJECTIVE: To assess dietary nutritional quality during dietary transition to a modified adult-style diet in the second year of life. DESIGN: A total of 55 children from 12 to 18 months old and their parents were studied. Dietary intake and indices of growth were measured monthly. Dietary data were collected monthly and tabulated using the Minnesota Nutrient Data System. Data were evaluated using repeated-measures analysis of variance, time trend, and correlational analyses. RESULTS: Mean energy intake increased from 12 to 18 months of age (926+/-24 kcal to 1062+/-33 kcal) with contributions from energy-yielding macronutrients remaining relatively constant. Throughout the study, fat intakes were below 30% of energy for 22% to 33% of the sample. Micronutrient intake patterns were diverse with intake for some nutrients (vitamins A, C, B(6), B(12), and D and calcium) remaining above recommended levels despite changes over the course of the study. Folate intakes increased from 79% of the recommended value at 12 months old to approximately 100% at 18 months old. Zinc and vitamin E intakes were well below recommended levels throughout the study, and iron decreased markedly from 96% of the recommended level at 12 months old to 76% at 18 months old. APPLICATIONS/CONCLUSIONS: These data show that intakes of some key nutrients are low during the period of dietary transition in early childhood, and intakes for some nutrients actually decrease despite increases in energy intake. Furthermore, because a considerable portion of children studied were consuming low-fat diets, it is clear that many parents are not following the only pediatric nutrition recommendations that currently exist. These findings argue strongly for the development of dietary guidance that not only addresses fat restriction, but also assists parents in selecting diets that support optimum growth and development in young children.nutrient intake, infants, dietary density.

Diet↗
PubMed1999

Immune function did not decline with aging in apparently healthy, well-nourished women.

Nutrition plays a crucial role in immune function. Most studies on age-associated changes in immunocompetence in healthy adults did not examine the nutritional status of participants extensively. Inadequate nutritional status may confound the relationship of aging and immune response. The purpose of this study was to examine age-related changes in parameters of acquired and innate immunity in healthy and generally well-nourished older (62-88 years) versus younger (20-40 years) women. Subjects were screened for participation using the health criteria of the SENIEUR protocol as well as a number of nutrition criteria related to undernutrition, and protein, iron, vitamin B12, and folate status. Young and old women did not differ in total T (CD3+), T-helper (CD4+), or T-cytotoxic (CD8+) cell number. However, older women tended to have lower T-cell proliferation response to concanavalin A (P < 0.10) and significantly reduced response to phytohemagglutinin (P < 0.05). No age-related changes were noted in natural killer cell number or cytotoxicity. Phagocytosis and subsequent oxidative burst activity also did not differ between young and old women. Most immune parameters were not compromised with aging in this cohort of apparently healthy, well-nourished women. These findings highlight the importance of simultaneous examination of health and nutritional status in studies of immune function with aging.

Adult↗
PubMed1998

Self-selected diets of lactating women often fail to meet dietary recommendations.

OBJECTIVE: To assess longitudinally nutrient intakes of lactating women during the postpartum period. DESIGN: Dietary data from lactating women were collected by means of 2-day food records at 3 and 6 months postpartum. Intake of energy and selected nutrients was tabulated and compared with dietary standards. SUBJECTS: The 52 lactating women enrolled in the study lived in a university community, were apparently healthy, had a body mass index within normal range, were successfully nursing a term infant, and planned to nurse for at least 6 months. STATISTICAL ANALYSES PERFORMED: Paired t tests and Stuart-Maxwell chi(2) analyses. RESULTS: Mean energy intakes were below the Recommended Dietary Allowance. Mean intakes of most nutrients met or exceeded recommended standards except for zinc and vitamins D and E at both 3 and 6 months postpartum. Calcium and folate intakes were also below standards at 6 months. Although mean iron intake exceeded the standard at both measurement times, there was a significant decline from 3 to 6 months. Relative frequencies of mothers meeting various percentages of standards differed significantly from 3 to 6 months for calcium; iron; folate; and vitamins E, D, and B-6. At 6 months, significant increases were noted in the number of women reporting calcium, folate, and vitamin B-6 intakes at less than one half of the recommended amounts. APPLICATIONS/CONCLUSIONS: Guidance for lactating women should stress food sources of nutrients likely to be limited in their diets: calcium; zinc; folate; and vitamins E, D, and B-6.

Adult↗
PubMed1998

Using encoding and retrieval strategies to improve 24-hour dietary recalls among older adults.

OBJECTIVE: To examine whether using an encoding strategy and/or providing more support at the time of retrieval improves the accuracy of 24-hour dietary recalls among the elderly. DESIGN: Posttest-only control group design. SETTING: The sample was recruited through advertisements and at senior centers and a low-income apartment building in rural central Pennsylvania. SUBJECTS: Study participants were 21 men and 73 women aged 58 years old and older. Everyone completed the study. INTERVENTION: The treatment group was unobtrusively guided in use of an encoding strategy before consuming the prepared meal. MAIN OUTCOME MEASURES: A 24-hour dietary recall and recognition tests were administered the next day for the foods consumed at the meal and for serving sizes of 5 of the foods. Memory tests were also administered. STATISTICAL ANALYSES PERFORMED: Linear regression was used to examine differences between the treatment and control groups and to identify variables that explained variation in the number of foods correctly recalled or recognized. The Chi 2 test was used to examine correct vs incorrect recall or recognition of the serving sizes of the 5 foods between the groups and to identify explanatory variables for this task. RESULTS: Subjects remembered more foods when they used an encoding strategy and when recognition replaced free recall; they performed best when both strategies were used. Use of this encoding strategy did not improve accurate recall or recognition of serving sizes of 5 foods; however, performances did improve when recognition replaced free recall. CONCLUSIONS: Among older adults, use of an encoding strategy and provision of support at the time of retrieval enhances memory of foods consumed but not of amounts consumed. To strengthen memory of foods consumed, older adults need to perform effortful memory tasks when they are eating.

Aged↗
PubMed1998

Time and cost for recruiting older adults.

OBJECTIVES: The purpose of this study was to examine the time requirements and costs of recruiting older adults for participation in a medical center-/university-sponsored, home-based nutrition education study. A two-step recruitment strategy consisting of an introductory letter followed by a telephone call was used. DESIGN: A random selection of 1300 individuals aged 60 to 74 years was drawn from a patient database of a large, rural, tertiary care hospital to receive introductory letters and recruitment telephone calls. One week after the mailing, potential subjects were contacted by trained interviewers and asked to participate in a home-based nutrition education study. PARTICIPANTS: Men and women, aged 60 to 74 years, whose names appeared in a rural, tertiary care hospital database. MEASUREMENTS: Recruitment rate, time required for recruitment by telephone, and cost of the combined mailing and telephone recruitment effort. RESULTS: Of the 1300 individuals selected, 1077 (83%) people were contacted by phone and 223 (17%) people were unable to be reached. A total of 2895 calling attempts were required to determine the recruitment status of those identified as potential participants. Of those reached by phone, the recruitment rate was 45%. The total cost (mailing, telephone, and database management) per recruited subject was $8.56. CONCLUSION: This study has helped to establish the costs of recruitment for home-based education interventions using a two-step strategy of an introductory mailing and follow-up telephone interview.

Aged↗
PubMed1998

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↗
PubMed1997

Predicting early nonelective hospital readmission in nutritionally compromised older adults.

This study determined predictors of early nonelective hospital readmission in 92 (49 women and 43 men) nutritionally compromised Medicare patients. Subjects ranged in age from 65 to 92 y and represented patients hospitalized previously for medical or surgical services. The study used a repeated-measures design of multiple variables representing demographics, anthropometric and clinical values, and functional status. Data were collected during hospitalization and during home visits at 1 and 3 mo postdischarge. There were 26 readmissions, making the 4-mo nonelective readmission rate 26%. Subjects who were readmitted nonelectively were compared with those not readmitted. Univariate analyses suggested strong relations between readmission outcome and serum albumin, total lymphocyte count, change in weight, and change in white blood cell count. Sociodemographic variables were less useful in predicting readmission than were measurements of patients' clinical status. Measurements of change in clinical variables were generally more predictive of readmission than was any one single measurement. Multivariate-logistic-regression analyses suggested a model consisting of change in weight and change in serum albumin from hospitalization to 1 mo after discharge as being highly predictive of early nonelective readmission. Individuals with any amount of weight loss and no improvement in albumin concentrations during the first month after hospitalization were at a much higher risk of readmission than were those who maintained or increased their postdischarge weight and had repleted their serum albumin concentrations. More study is warranted to clarify whether routine monitoring of changes in weight and serum albumin after hospitalization is appropriate in older adults.

Activities of Daily Living↗
PubMed1997

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↗
PubMed1996

Change in nutrient intakes, number of servings, and contributions of total fat from food groups in 4- to 10-year-old children enrolled in a nutrition education study.

OBJECTIVE: To determine change in nutrient intakes, number of servings, and contributions of total fat from food groups in children who lowered their dietary fat intake. DESIGN: A research and demonstration study designed to lower plasma low-density lipoprotein cholesterol level. There were four study groups: two intervention and two control groups. All children had hypercholesterolemia except for those in one control group. There 24-hour dietary recalls were collected on randomly assigned days over a 2-week period at baseline and 3 months after the intervention. SUBJECTS: Three hundred three 4-to 10-year old children from suburbs north of Philadelphia, Pa. INTERVENTIONS: One intervention involved a home-based, parent-child autotutorial program (PCAT group) with audiotaped stories and print materials for the children and their families; the other intervention involved one face-to-face counseling session with a registered dietitian (counseling group). OUTCOME MEASURES: Change in mean nutrient intakes compared with the Recommended Dietary Allowance (RDA); change in number of servings and mean grams of total fat contributed from 10 different food groups. STATISTICAL ANALYSES PERFORMED: Analyses of variance and chi 3 analyses. RESULTS: Children in every study group had mean intakes of all nutrients (except vitamin D) greater than 67% of the RDA 3 months after the baseline measurement. Several food groups (ie, meats, dairy products, fats/oils, and desserts) provided less total fat to the diets of children who reduced their dietary lipid intake after 3 months (i.e., PCAT and counseling groups). These children also reduced the mean number of servings selected from these food groups. Within these same food groups, some children consumed fewer servings of higher fat foods and more servings of lower fat foods. APPLICATIONS/CONCLUSIONS: Children who lowered their dietary fat intake after intervention reported both quantitative and qualitative changes in food choices from several food groups. These choices did not significantly reduce their nutrient intakes.

Aging↗