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J L Tillotson

Publications and source records attributed to J L Tillotson.

15 recordsLinked to original sources
PubMed1997

Methods of dietary and nutritional assessment and intervention and other methods in the Multiple Risk Factor Intervention Trial.

Various dietary assessment instruments were used in the Multiple Risk Factor Intervention Trial (MRFIT), either to assist with the special intervention program or to assess trial outcomes. For the latter purpose, the 24-h recall was the main method and was selected with the understanding that the single recall collected at baseline and at most annual visits--considered by itself--would be useful mainly for assessing groups rather than individuals. Major components of the data collection and analysis system developed for the 24-h recall included central training and certification of nutritionists, a central nutrient coding system, and a food grouping system to assist interventionists in using recall data for counseling. Several additional nutritional assessment methods were used for men in the special intervention group only to assist them in attaining the dietary goals. These goals consisted chiefly of reduced intake of saturated fat and cholesterol and a modest increase in intake of polyunsaturated fat; total fat intake was also decreased, primarily for control of energy intake. Short-term success at attainment of these nutritional goals was evaluated by means of 3-d food records collected before the intervention and after the initial 10-wk intensive intervention period. The MRFIT nutrient goals, which became more vigorous at certain points in the trial, were translated into food patterns. Adherence to these food patterns was also assessed by scoring of 3-d records and by subjective evaluation by nutritionists throughout the trial. Methods of collecting other trial data are also described in this chapter.

Blood Pressure↗
PubMed1997

Food group and nutrient intakes at baseline in the Multiple Risk Factor Intervention Trial.

This chapter relates food and nutrient intakes at baseline to other facets of reported dietary behavior, major risk factors, and sociodemographic characteristics of men in the Multiple Risk Factor Intervention Trial. Intakes of total fat (38.4% of energy), saturated fatty acids (14.2%), and dietary cholesterol (492 mg/d) were similar to amounts seen in the first and second National Health and Nutrition Examination Surveys in the 1970s and were generally lower than findings from studies in the 1960s. There were inverse relations between total serum cholesterol and intakes of total fat, saturated and monounsaturated fatty acids, and dietary cholesterol. These paradoxical associations were largely attributable to findings in the 21% of men who reported following a special diet, indicating that use of such a diet increases with severity of hypercholesterolemia. Fat intake was directly related to number of meals per week eaten away from home, and to cigarette smoking. Patterns of food and nutrient intake were similar for men stratified by baseline blood pressure and antihypertensive treatment. Intake of total energy and percentages from various dietary fats decreased with age, as did use of sucrose and caffeine. White men consumed more dairy products than did other ethnic groups, whereas black men consumed more eggs, sugars, and sweets. Asians had the highest intake of cereal foods. Those with more education ate less high-fat meat products, more fruit, and more polyunsaturated oils, but also more high-fat dairy products and less breads and cereals; they also drank more alcohol.

Alcohol Drinking↗
PubMed1997

Food group and macronutrient intakes, trial years 1-6, in the special intervention and usual care groups in the Multiple Risk Factor Intervention Trial.

This chapter presents changes in dietary intake reported by men in the special intervention (SI) and usual care (UC) groups from baseline through 6 y of follow-up in the Multiple Risk Factor Intervention Trial. Changes in nutrients by SI men after 1 y of following the intensive intervention program were as follows: reduced intake of total fat (from 38.4% to 34.3% of energy), saturated fatty acids (14.2% to 10.4% of energy), and cholesterol (448 to 263 mg/d), and increased intake of polyunsaturated fatty acids (from 6.4% to 8.6% of energy). These changes were maintained and did not increase through the remaining 5 y. UC men reported small changes in similar directions. Most of the change in saturated fatty acid intake by SI participants was from high-fat meat and high- and medium-fat dairy products. Reduction in dietary cholesterol was achieved primarily by substantial decreases in intake of eggs and high-fat meats. Several baseline factors were associated with amount of dietary change in SI men. Greater changes were seen in men with higher baseline serum cholesterol concentrations, in those not consuming a special diet, in nonsmokers followed by lighter smokers, in hypertensive than in non-hypertensive men, in older participants, in white than in black men, in moderate drinkers than in nondrinkers or those consuming > or = 22 drinks/wk, and in those with no "stressful life events" than in those reporting one or more life events.

Cholesterol, Dietary↗
PubMed1997

Relation of dietary carbohydrates to blood lipids in the special intervention and usual care groups in the Multiple Risk Factor Intervention Trial.

This chapter explores relations between reported intake of dietary carbohydrates and measurements of plasma lipids at baseline and during trial years 1-6 of the Multiple Risk Factor Intervention Trial. With control for dietary lipids, alcohol, and other factors, total carbohydrate intake at baseline was inversely related to baseline plasma total cholesterol and high-density-lipoprotein (HDL) cholesterol; starch and other simple carbohydrates were unrelated to plasma lipids and sucrose was inversely related to HDL cholesterol. During trial years 1-6, men assigned to the special intervention group increased their intake of starch and other simple carbohydrates as they decreased their fat intake, and lowered their intakes of refined and processed sucrose. Total carbohydrate intake of these men was inversely related to total, low-density-lipoprotein (LDL), and HDL cholesterol. Starch and sucrose intakes were also inversely related to HDL cholesterol. In contrast, intake of other simple carbohydrates was directly related to HDL, and inversely related to plasma total and LDL cholesterol. For men in the highest quintile of intake of other simple carbohydrates compared with men in the lowest quintile, plasma total cholesterol was lower by 3.6 mg/dL, LDL cholesterol was lower by 4.3 mg/dL, and HDL cholesterol was higher by 1.6 mg/dL. Findings were generally similar for men in the usual care group.

Dietary Carbohydrates↗
PubMed1997

Relation of dietary fiber to blood lipids in the special intervention and usual care groups in the Multiple Risk Factor Intervention Trial.

This chapter addresses relations between intake of fiber--total, soluble, and insoluble--and blood lipids in the Multiple Risk Factor Intervention Trial through use of baseline data (single measurement), averages of four to five 24-h recalls and blood lipid determinations collected during annual follow-up examinations, and change from baseline to follow-up. No significant associations were observed at baseline. Consistent highly significant inverse associations were seen in analyses of follow-up measurements. Results from change data were of intermediate strength and consistency. These variations were in all likelihood due to the low reliability of a single 24-h recall at baseline for determination of dietary intake and change in intake for individuals. From follow-up data, plasma total and low-density-lipoprotein (LDL) cholesterol concentrations were lower by approximately 5 mg/dL for men in the special intervention group in quintile 5 of total fiber intake (25 g/d) compared with men in quintile 1 (8 g/d), after adjustment for average body mass index and intake of alcohol, saturated and polyunsaturated fatty acids, and dietary cholesterol. Results were similar for men in the usual care group. There were no adverse effects on high-density-lipoprotein cholesterol, nor any consistent associations with plasma triglycerides. Thus, increasing dietary fiber can provide additional reduction in blood total and LDL cholesterol and consequent improvement in the lipid profile, over and above the beneficial effects of a fat-modified diet.

Clinical Trials as Topic↗
PubMed1997

Relation of smoking at baseline and during trial years 1-6 to food and nutrient intakes and weight in the special intervention and usual care groups in the Multiple Risk Factor Intervention Trial.

This chapter describes dietary composition according to cigarette smoking status at baseline and changes in smoking status during follow-up for men in the special intervention (SI) and usual care (UC) groups of the Multiple Risk Factor Intervention Trial. Five patterns of smoking behavior were defined: 1) sustained nonsmoking, 2) early (years 1-2 of the trial) sustained quitting, 3) late (years 3-6 of the trial) sustained quitting, 4) recidivism, and 5) continued smoking. SI men who quit smoking showed greater favorable changes in dietary lipid composition and micronutrient intake than did continued smokers, and these changes were in many instances as great as favorable changes made by nonsmokers. On the other hand, SI men who quit smoking gained an average of 3.8 lb (1.7 kg), in contrast with nonsmokers who lost an average of 6.4 lb (2.9 kg). The gain by SI quitters was, however, less than that by UC quitters, who gained 6.5 lb (3.0 kg). Moreover, despite weight gain, net change in high-density-lipoprotein (HDL) cholesterol for SI quitters was positive. With the associated decrease in low-density-lipoprotein (LDL) cholesterol, early SI quitters had the most improvement in ratio of LDL to HDL among all subgroups. Thus, unfavorable nutritional patterns of smokers put them at double jeopardy regarding cardiovascular and other chronic diseases; additionally, long-term risks can be improved not only by smoking cessation but also by achievement of healthier eating patterns.

Body Weight↗
PubMed1986

Quality control in the Multiple Risk Factor Intervention Trial Nutrition Modality.

One of the principal objectives of the MRFIT was to teach and motivate participants assigned to the SI group to adhere to a fat-controlled dietary regimen over the course of the trial. The magnitude of the trial (with more than 12,000 participants, half of them assigned to the SI protocol, to be followed for at least 6 years in 22 separate centers) presented new challenges for maintenance of quality control over a nutrition intervention program. Collection of data to monitor changes in dietary intake over time in SI and UC groups, as well as information to assess dietary adherence levels in SI participants also presented large-scale challenges in maintenance of quality control. The MRFIT formulated many of its initial nutrition intervention and data collection decisions based on experience of the earlier National Diet Heart Study (NDHS). In order to avoid coding 7-day dietary records by local clinic nutritionists (as in NDHS), the trial opted for collection of 24-hour dietary recalls that were coded centrally at the Nutrition Coding Center. It necessitated extra attention to training and certification of clinic nutritionist-interviewers to be certain that NCC coders had sufficiently precise information about all foods entered on dietary recall forms. Since dietary intake data were collected over a time span of approximately 10 years, procedures for updating the food composition database and coding rules were a necessity. Continuing attention to training and monitoring of performance of clinic nutritionist-interviewers also was important. The MRFIT nutrition intervention program was designed with the need for interclinic comparability of intervention techniques in mind. This required not only development of study-wide nutrition intervention materials, but also necessitated ongoing attention to staff training and monitoring procedures in order to ensure intercenter comparability of efforts. The success of the nutrition intervention modality depended upon the continuing efforts of the nutrition counselors not only to achieve dietary adherence but also to monitor levels of dietary adherence over time. The NDHS experience served as a springboard for designing the MRFIT nutrition intervention and data collection procedures. It is hoped that techniques for maintaining and monitoring quality control over the MRFIT nutrition modality as outlined in this chapter may prove useful to future planners.

Certification↗
PubMed1986

Dietary intake in the Multiple Risk Factor Intervention Trial (MRFIT): nutrient and food group changes over 6 years.

The Multiple Risk Factor Intervention Trial (MRFIT) was a randomized clinical trial in the primary prevention of coronary heart disease. Middle-aged men determined to be at high risk for coronary heart disease were randomized into either a special intervention (SI) group or a group referred to usual sources of medical care (UC). Twenty-four hour dietary recall data were used to monitor the nutrient intake of the MRFIT population and guide the nutrition education program for the SI group. The SI group of participants decreased intake of dietary cholesterol by 40% and saturated fatty acids by more than one-fourth and increased intake of polyunsaturated fatty acids by one-third. Evaluation of SI dietary intake data by food groups indicates that some dietary changes were relatively easy to implement, whereas others presented more of a challenge. Changes made with relative ease included increasing the consumption of fish and poultry, skim and low-fat milk, polyunsaturated margarines and oils, fruits, and low-fat breads and cereals and reducing the consumption of egg yolks. More difficult changes included eliminating, or even reducing, the intake of high-fat beef and pork, high-fat cheeses, high-fat crackers, snacks, and desserts, and increasing the intake of vegetarian meat alternatives.

Cholesterol, Dietary↗
PubMed1984

Critical behaviors in the dietary management of hypertension.

An interdisciplinary group convened by the National High Blood Pressure Education Program (NHBPEP) was charged with describing the patient behaviors critical to successful dietary management of high blood pressure. The group's report identifies 10 steps the patient must take to change dietary behavior; it emphasizes a gradual, progressive approach and ongoing patient contact with the health care team. The approach should interest the dietary counselor and might serve as an example of how progressive nutrition counseling programs can be built around a behavioral model. The report should stimulate the continuing efforts of the nutrition counselor, the physician, the health care administrator to improve the nutrition care of the patient.

Behavior Therapy↗
PubMed1981

Nutrition data collection in the Multiple Risk Factor Intervention Trial (MRFIT). Baseline nutrient intake of a randomized population.

Selected preliminary baseline nutrient intake data for volunteers participating in the MRFIT study have been presented. Because of the unique selection criteria applied, nutrient intake trends described may not be generalized to the overall population. Nonetheless, present-day trends in this particular group seem to be toward dietary intakes lower in total fat, saturated fat, and dietary cholesterol and higher in polyunsaturated fat than those documented in earlier studies. Thus, utilizing the dietary methodology which has evolved through NHLBI's ongoing program of research investigations, it appears that the health-conscious men randomized into the MRFIT were already consuming diets somewhat more prudent than those in an earlier generation of studies.

Adult↗
PubMed1980

Assessing dietary adherence in the Multiple Risk Factor Intervention Trial (MRFIT). I. Use of a dietary monitoring tool.

Participants in the Multiple Risk Factor Intervention Trial (MRFIT) were taught not only how to modify the fat content of their diets but also how to assess their success in doing so. To simplify the process, a food scoring system was developed in which positive points are assigned to high-saturated-fat and high-cholesterol foods and negative points to foods and high-polyunsaturated-fat and low-cholesterol content. Using special forms supplied by MRFIT nutrition counselors, participants were able to self-monitor their dietary regimens. The method is described and forms are illustrated.

Coronary Disease↗
PubMed1978

Behavioral science and nutrition: a new perspective.

Increasing collaboration of nutritionists and behavioral scientists is needed in order to bring about desirable long-term changes in eating patterns. The National Heart, Lung, and Blood Institute's growing interest in this area is described, and recent examples of such collaboration are noted. The two papers which follow--one emanating from the area of social psychology, the other from behavior modification--are introduced.

Adult↗