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Biomedical subjects

Johanna Dwyer

Publications and source records attributed to Johanna Dwyer.

At least 19 recordsLinked to original sources
PubMed2006

Dietary vitamin K variability affects International Normalized Ratio (INR) coagulation indices.

BACKGROUND: Changes in daily vitamin K intake may contribute to marked variations in the International Normalized Ratio (INR) coagulation index in patients receiving oral warfarin anticoagulant therapy, with potentially serious adverse outcomes. Thus, patients receiving warfarin therapy are routinely counseled regarding this drug-nutrient interaction and are instructed to maintain consistent vitamin K intakes, though little quantitative information about this relationship is available. OBJECTIVE: To determine the quantitative impact of variability in dietary vitamin K(1) (phylloquinone) intake, assessed by a validated patient self-monitoring instrument, on weekly INR in patients receiving warfarin anticoagulant therapy. METHODS: A prospective dietary assessment study was conducted at the Massachusetts General Hospital in Boston. Sixty outpatients (37 males and 23 females) were selected with a mean age 60.3 +/- 16.8 years, who began oral warfarin anticoagulant therapy within 14 days prior to their first clinic visit to an outpatient anticoagulation therapy unit. Exclusion criteria included more than 2 drinks of alcohol per day, inability to speak English, and concurrent disease states affecting warfarin therapy such as liver disease and terminal illness. Over the five-week study period, participants recorded daily intakes in specified amounts of all food items appearing on a validated dietary self-assessment tool. Concomitant use of prescription and/or non-prescription medications was also obtained. Concurrent daily warfarin dose and adherence to the drug regimen, concomitant use of prescription and/or non-prescription medications known to interact with warfarin, and weekly INR were obtained. Week-to-week changes in vitamin K intake, warfarin dose, and INR were determined and cross-correlated. RESULTS: Forty-three patients (28 males and 15 females) completed the study and 17 dropped out. Pearson's correlation coefficient revealed the variability in INR and changes in vitamin K intake were inversely correlated (r = -0.600, p < 0.01). Multiple regression analysis (r = 0.848) indicated that a weekly change of 714 mug dietary vitamin K significantly altered weekly INR by 1 unit (p < 0.01) and a weekly change of 14.5 mg warfarin significantly altered weekly INR by 1 unit (p < 0.01) after adjustment for age, sex, weight, height, and concomitant use of medications known to interact with warfarin. CONCLUSIONS: Patients taking warfarin and consuming markedly changing amounts of vitamin K may have a variable weekly INR with potentially unstable anticoagulant outcomes.

Aged↗
PubMed2006

Intake of specific flavonoids and risk of acute myocardial infarction in Italy.

OBJECTIVE: As intake of flavonoids has been associated with reduced risk of coronary heart disease but data on the relation with specific classes of flavonoids are scarce, we assessed the relation between dietary intake of specific classes of flavonoids and the risk of acute myocardial infarction (AMI) in an Italian population. DESIGN: Case-control study. Dietary information was collected by interviewers on a questionnaire tested for validity and reproducibility. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were obtained by multiple logistic regression models including terms for energy and alcohol intake, as well as sociodemographic factors, tobacco and other major recognised risk factors for AMI. SETTING: Milan, Italy, between 1995 and 2003. SUBJECTS: Cases were 760 patients, below age 79 years, with a first episode of non-fatal AMI, and controls were 682 patients admitted to hospital for acute conditions unrelated to diet. RESULTS: A reduced risk of AMI was found for increasing intake of anthocyanidins (OR=0.45, 95% CI 0.26-0.78 for the highest vs. the lowest quintile, Ptrend=0.003) and flavonols (OR=0.65, 95% CI 0.41-1.02, Ptrend=0.02). A tendency towards reduced risks, although not significant, was observed for flavan-3-ols (OR=0.73, 95% CI 0.48-1.10) and total flavonoids (OR=0.74, 95% CI 0.49-1.14). No meaningful heterogeneity was found between the sexes. No association emerged for other flavonoids, including isoflavones, flavanones and flavones. CONCLUSIONS: High intake of anthocyanidins reduced the risk of AMI even after allowance for alcohol, fruit and vegetables, supporting a real inverse association between this class of flavonoids and AMI risk.

Acute Disease↗
PubMed2006

Starting down the right path: nutrition connections with chronic diseases of later life.

Thirty years have been added to the average life expectancy of Americans over the past century. It is a reasonable expectation that Americans will achieve an average life span of > or =100 y within this century. The most dramatic decreases in early-life and midlife mortality coincided with advances in medicine; curative medicine has played a lesser role. The aging of the population alone has already increased health care costs, and as we move toward even longer lives, these costs will likely increase even more. Therefore, establishing and safeguarding optimal health from early life must become increasingly important concerns for governments and health care providers if they are to allocate resources wisely and ensure and maintain a high quality of life in the population. A prevention-oriented, life cycle approach is critical to establishing and maintaining health throughout life. This approach can delay and compress morbidity and the social toll associated with chronic disease and disability for as long as possible into old age. Good evidence exists that early nutrition affects key risk factors for chronic degenerative diseases of middle and later life, such as osteoporosis and cardiovascular disease. The influence of nutrition on health status and morbidity supports primary, secondary, and tertiary prevention of disease and intervention strategies at each point in the process. The objective of such a prevention-oriented model is to enable people to live well for longer, while minimizing chronic disability. Starting down the right path with appropriate nutrition and staying on it by eating well are important components of healthy aging.

Aged↗
PubMed2005

Flavonoids and breast cancer risk in Italy.

Few epidemiologic studies have investigated the potential relation between flavonoids and breast cancer risk. We have applied recently published data on the composition of foods and beverages in terms of six principal classes of flavonoids (i.e., flavanones, flavan-3-ols, flavonols, flavones, anthocyanidines, and isoflavones) on dietary information collected in a large-case control study of breast cancer conducted in Italy between 1991 and 1994. The study included 2,569 women with incident, histologically confirmed breast cancer, and 2,588 hospital controls. Odds ratios (OR) and 95% confidence intervals were estimated by multiple logistic regression models. After allowance for major confounding factors and energy intake, a reduced risk of breast cancer was found for increasing intake of flavones (OR, 0.81, for the highest versus the lowest quintile; P-trend, 0.02), and flavonols (OR, 0.80; P-trend, 0.06). No significant association was found for other flavonoids, including flavanones (OR, 0.95), flavan-3-ols (OR, 0.86), anthocyanidins (OR, 1.09), as well as for isoflavones (OR, 1.05). The findings of this large study of an inverse association between flavones and breast cancer risk confirm the results of a Greek study.

Adult↗
PubMed2005

Eating disorder in a hemodialysis patient: case report.

Renal replacement therapy may encourage eating disorders in some patients. Hemodialysis requires patients to attend dialysis sessions three times per week, during which time they are weighed pre- and post-treatment, so the importance of limiting "fluid weight" gains to prevent fluid overload and elevated blood pressure are constantly reinforced by the dialysis team. Patients must also follow rigorous therapeutic dietary modifications to prevent the buildup of urea and harmful waste products between treatments. This is a case report of a 30-year-old man receiving renal replacement therapy who had anorexia nervosa of the bulimic subtype.

Adult↗
PubMed2004

Influence of dietitian presence on outpatient cardiac rehabilitation nutrition services.

To describe variations in nutrition services offered in a nationally representative sample of out-patient cardiac rehabilitation programs by presence of a registered dietitian (RD), a survey was conducted of 250 randomly selected centers from 1,111 US outpatient cardiac rehabilitation centers in the 1998/1999 Cardiac Rehabilitation Directory of the American Association of Cardiovascular and Pulmonary Rehabilitation. A total of 190 of the 250 surveys (76%) were returned. Nutrition services offered by programs polled included distribution of nutrition pamphlets, one-on-one nutrition counseling, group nutrition classes, guest lectures on nutrition, and cooking demonstrations. Cardiac rehabilitation programs with an RD offered significantly more nutrition services on average (4.2+/-1.2) than programs without an RD (3.5+/-1.1, P=.01). Programs with RDs were more likely to offer one-on-one nutrition counseling than programs without them (98% and 80% respectively, P<.001), and they were also more likely to offer cooking demonstrations (43% and 17% respectively, P=.02). More, and a greater variety of, nutrition services are offered in cardiac rehabilitation programs that have an RD. Without an RD, exercise physiologists and registered nurses often provide some, but fewer and different, nutrition services.

Cooking↗
PubMed2004

Flavonoid intake in relation to lung cancer risk: case-control study among women in Greece.

We have examined the role of three classes of flavonoids that are relatively common in the Greek diet (flavanones, flavan-3-ols, and flavonols) in the etiology of lung cancer using data from a case-control study among women, which was undertaken in Athens, Greece, in the late 1980s. Study subjects were 154 women with lung cancer and 145 control women with orthopedic conditions. Women reported their life-long smoking histories and average frequency of consumption, before onset of present disease, of 47 food items or beverages that collectively covered >80% of the intake of each of the energy-providing nutrients. Intakes of flavonoids were calculated using the recently published U.S. Department of Agriculture database. The data were modeled through logistic regression, controlling for energy intake and smoking. There was no indication that intake of any of the studied flavonoid categories reduces the risk of lung cancer; indeed, for flavonols there was an unexpected positive association. Thus, our study does not indicate a protective effect of flavanones, flavan-3-ols, or flavonols on lung cancer risk and indicates that the factors responsible for the protective effect of vegetables and fruits against the risk of this cancer are unlikely to belong to these flavonoid categories.

Case-Control Studies↗
PubMed2003

Effects of dietary intake, appetite, and eating habits on dialysis and non-dialysis treatment days in hemodialysis patients: cross-sectional results from the HEMO study.

OBJECTIVE: To evaluate differences between dietary energy intake (DEI), dietary protein intake (DPI), appetite, dietary patterns, and eating habits during dialysis treatment days (DD) and non-dialysis treatment days (NDD) in 1,901 adults receiving maintenance hemodialysis who were enrolled in the baseline phase of the National Institutes of Health-sponsored Hemodialysis (HEMO) study. DESIGN: A cross-sectional analysis of participants at baseline (before randomization). SETTING: Fifteen clinical centers across the United States. MEASUREMENTS: DEI, DPI, and self-reported assessment of appetite, dietary patterns, and eating habits. RESULTS: For the entire study cohort, total mean (+/- SD) DEI (1,566 +/- 636 kcal/day) and weight-adjusted DEI (23.2 +/- 9.5 kcal/kg/day) were significantly higher (P <.0001) on NDD than on DD (1,488 +/- 620 kcal/day and 22.2 +/- 9.6 kcal/kg/day), respectively. Similarly, DPI was significantly higher (P <.0001) on NDD (65.0 +/- 29.0 g/day and 0.96 +/- 0.43 g/kg/day) than on DD (60.2 +/- 26.5 g/day and 0.90 +/- 0.41 g/kg/day). On DD and NDD, the mean weight-adjusted DEI for the entire cohort was less than the HEMO study standard of care (SOC) of > or =28 kcal/kg/day, whereas on NDD, several subgroups reported dietary protein intakes that were closer to the study's SOC. These included men, patients under 50 years of age, nonblack participants, those without diabetes, those with a normal or mild Index of Co-Existing Disease score, and those on dialysis for more than 5 years. Protein and energy intakes declined with worsening self-reported appetites in both DD and NDD after adjusting for other subgroup effects. CONCLUSION: Dietary energy and protein intakes of HEMO study participants were lower on DD than on NDD, and also lower than the SOC on both days, particularly with regard to energy intake. People receiving maintenance hemodialysis should be counseled to consume adequate amounts of energy and protein daily, especially on DD. Practitioners should monitor closely those patients who report poor appetite and should intervene appropriately.

Adult↗
PubMed2003

Do we need a nutrition-specific quality of life questionnaire for dialysis patients?

Food, eating, and quality of life are intimately related. Available generic and disease-specific health-related quality of life (HRQOL) instruments address nutrition only with respect to the ability to eat and omit more dynamic components of nutrition such as sensory enjoyment of food and food intake. For improved assessment and monitoring of nutrition-related quality of life in hemodialysis patients, a nutrition-specific questionnaire is recommended, consisting of two tools: the Appetite and Dietary Assessment Tool (ADAT), already used in many dialysis clinics, and the nutrition-specific Food Enjoyment in Dialysis (FED) questionnaire which asks 10 additional questions on sensory changes, thirst, gastrointestinal symptoms, side effects from medications and/or dialysis, and feelings of satisfaction and control. This nutrition-specific information should permit comprehensive evaluation and monitoring of changes in nutrition related quality of life. When coupled with generic and disease specific tools, it will provide a complete picture of quality of life in hemodialysis patients.

Eating↗
PubMed2003

Nutritional status assessed from anthropometric measures in the HEMO study.

OBJECTIVE: Anthropometric methods are screening techniques for assessing nutritional stores of fat and lean tissues among persons with renal disease. This report presents cross-sectional baseline data on anthropometric indicators of nutritional status from a group of hemodialysis patients in a multicenter clinical trial, the Hemodialysis (HEMO) Study. DESIGN: The HEMO Study is a prospective, multicenter, randomized, 2 x 2 factorial clinical trial to evaluate the efficacy of the delivered dose of dialysis, defined by Kt/V, and membrane flux in reducing morbidity and mortality in (maintenance) hemodialysis patients. Standardized measures of weight, stature, body mass index (BMI), arm and calf circumference, and triceps and subscapular skinfolds were taken immediately after dialysis. The analytic methods consisted of univariate statistics, including means, standard deviations, and selected percentiles presented as tables of descriptive statistics. Study findings were compared with corresponding national reference data from the Second National Health and Nutrition Examination Survey (NHANES II). PATIENTS: Eligible patients between 18 and 80 years of age on chronic hemodialysis for at least 3 months, receiving hemodialysis 3 times per week and with a residual renal clearance of < 1.5 mL/min were examined. Patients also had to be able to attain an eKt/V of > or = 1.45 in 4.5 hours or an anthropometric volume < 45 to 50 L thus excluding persons with body weights over about 85 kg. The study sample consisted of the first 1,000 randomized patients, 464 men and 536 women; 642 blacks, 318 whites; and 40 of other racial backgrounds out of 1,847 randomized. RESULTS: Differences in nutritional status by sex, race, duration of dialysis, and comorbid disease were found among these patients enrolled in the HEMO Study. In comparison with NHANES II, these hemodialysis patients were, on average, lighter with less adipose and muscle tissue than healthy persons of the same ages. These findings can be indicators of persons with chronic disease. Those with diabetes were overweight based on their BMI values. CONCLUSION: These HEMO Study data provide a clinical reference for the use of these anthropometric indicators in assessing the nutritional status of contemporary hemodialysis patients weighing < 85 kg.

Adolescent↗
PubMed2003

Sodium bromide by instrumental neutron activation analysis quantifies change in extracellular water space with wound closure in severely burned children.

BACKGROUND: The ability to measure extracellular water (ECW) in critically ill patients can significantly enhance current methods of assessing fluid homeostasis, body composition, and response to nutritional therapy. We measured corrected bromide space to determine change in ECW with wound closure among acutely burned children. METHODS: Fifteen children with burns over 30% of their total body surface area had their ECW determined following hemodynamic stabilization and when wound closure was complete. Plasma samples were obtained at baseline and 4 hours after receiving 25 mg/kg of sodium bromide. Plasma bromide was quantified by instrumental neutron activation analysis. RESULTS: Mean CBS decreased with wound closure (9.1 +/- 4.1 vs 7.9 +/- 3.9 liters; P =.04), indicating a significant decrease in ECW over the course of recovery. A decline in weight also occurred over the same period (32.4 +/- 15.2 vs 29.1 +/- 13.5 kg; P =.007); however, change in corrected bromide space as a proportion of weight was not statistically significant. CONCLUSION: A significant decrease in ECW accompanies the weight loss observed in patients following wound closure. Measurement of bromide dilution space is a convenient method for monitoring ECW that can be done at the bedside.

Acute Disease↗
PubMed2003

Fermentable and nonfermentable fiber supplements did not alter hunger, satiety or body weight in a pilot study of men and women consuming self-selected diets.

Little is known about the relative effects of fermentable fiber (FF) vs. nonfermentable fiber (NFF) on energy regulation in humans. We compared 27 +/- 0.6 g/d supplements of FF (pectin, beta-glucan) and NFF (methylcellulose) for their ability to decrease ad libitum energy intake (EI) and hunger, increase satiety and cause spontaneous body weight and fat losses. Men and women (n = 11) aged 23-46 y, BMI 20.0-34.4 kg/m2, consumed first NFF and then FF for 3 wk each, with a 4-wk washout period between phases. Daily satiety assessed with analog scales was higher with NFF than FF (60.7 +/- 1.0 vs. 57.7 +/- 0.8 mm, P = 0.01). However, there were no differences in reported EI (NFF < FF by 7%, P = 0.31, NFF < baseline by 9.5%, P = 0.11), body weight (NFF 0.13 kg, P = 0.73; FF 0.13 kg, P = 0.60) or fat percentage (NFF -0.3%, P = 0.56; FF -0.1%, P = 0.66) within either phase. In contrast to findings in animals, NFF was more, rather than less satiating than FF, and use of neither NFF nor FF preparations was associated with body weight or fat loss. These pilot results suggest no role for short-term use of FF and NFF supplements in promoting weight loss in humans consuming a diet ad libitum.

Adult↗
PubMed2003

Future directions for the integrated CSFII-NHANES: What We Eat in America-NHANES.

The history of the integration of the dietary data collection from the National Health and Nutrition Examination Survey (NHANES) and the Continuing Survey of Food Intakes by Individuals (CSFII) is reviewed. The purposes and process of the workshop are presented. The three key topics of the workshop are summarized. The key roles of cosponsors and participants are acknowledged.

Consensus Statements as Topic↗
PubMed2003

Collection of food and dietary supplement intake data: What We Eat in America-NHANES.

This paper describes the collection process for the integrated dietary component of the National Health and Nutrition Examination Survey(NHANES) 2002 (entitled What We Eat in America-NHANES), referred to here as the integrated survey. The dietary components of previous NHANES cycles and the Continuing Survey of Food Intake in Individuals (CSFII) are also described. The collection process for foods in the integrated survey consists of an in-person 24-h recall using a computerized 5-step method and a second nonconsecutive 24-h recall via telephone. A food frequency questionnaire is being pilot-tested to provide information on the propensity to consume certain foods. Dietary supplement intakes over the past 30 d are assessed for all persons during the household interview. Other diet-related data are also obtained. Strengths of the integrated survey include information on food and supplement intakes in a representative sample of the civilian noninstitutionalized population of the United States that can be linked to anthropometric, biochemical, clinical and disease history information in NHANES. After reviewing the current state of the art on dietary and dietary supplement data collection, discussion groups consisting of members of key stakeholder community concluded that, although the most advanced methods for dietary data collection available are being used, the differences between how information on food and dietary supplement intakes is collected make it challenging to combine data describing nutrients from both sources to obtain estimates of total nutrient intakes. The discussion groups concluded that more research is needed on these issues and provided key recommendations for future efforts in this important area of public health surveillance.

Adult↗
PubMed2003

Estimation of usual intakes: What We Eat in America-NHANES.

Usual intakes of nutrients are reliable indicators for making associations between diet and health or disease risks. Estimates of consumption of specific foods and food groups are also important for evaluating the progress in meeting key objectives in such national public health initiatives as Healthy People 2010. Reliable and valid estimates of intakes of particular foods, food ingredients, dietary supplements and other bioactive substances are also needed for dietary assessment and regulatory purposes. The ability to generate useful estimates of these constituents often requires much larger sample sizes than are needed for estimating nutrient intakes. Statistical methods recommended by the National Academy of Sciences are described that provide estimates of distributions of usual nutrient intakes and permit dietary assessment and planning at the population level. Statistical and modeling approaches for estimating intakes of foods, dietary supplements and other bioactive substances are also summarized. Based on the deliberations of discussion groups consisting of members of key stakeholder groups involved in the planning, implementation and utilization of national survey data, a high priority was placed on the need for more research to determine the best approaches for applying these methods to dietary data in the integrated What We Eat in America-National Health and Nutrition Examination Survey (NHANES).

Aged↗
PubMed2003

Food and dietary supplement databases for What We Eat in America-NHANES.

Relative strengths and potential approaches for improvement of food and dietary supplement databases used for tabulating intakes from the dietary component of the What We Eat in America-National Health and Nutrition Examination Survey (NHANES) are discussed. The U.S. Department of Agriculture's Nutrient Data Laboratory develops and maintains the Nutrient Databank System (NDBS) and many nutrient-specific and population-specific databases. NDBS contains data for approximately 8,000 foods and approximately 115 components; tables for compounds of special interest are also available. Nutrient databases need constant revision because of a constantly changing food supply. The completeness of analytical data varies from nutrient to nutrient. The National Center for Health Statistics developed and maintains a database of dietary supplements based on label information. To date, no verification of ingredients has been undertaken. The development of a dietary supplement database containing analytical values would require extensive resources but would be valuable. Databases for vitamin and mineral supplements are compatible with food databases. Databases for botanicals and other supplements include nonnutrient constituents that may not be documented in food composition databases. Gaps in food and dietary supplement composition data exist because of limited resources, changing availability of foods and products and the advent of new compounds of health interest. More data are needed on nutrients and other bioactive constituents in foods and dietary supplements. Analytical methods do not exist for all ingredients or active constituents in foods and dietary supplements. Research needs for further development of meaningful food and dietary supplement databases are similar.

Databases, Factual↗
PubMed2003

How the CATCH eat smart program helps implement the USDA regulations in school cafeterias.

This article describes the implementation of the U.S. Department of Agriculture's National School Lunch Program (NSLP) standards in school lunch menus in 56 intervention and 20 control schools from the Child and Adolescent Trial for Cardiovascular Health (CATCH) 5 years after the main trial, compared with 12 schools previously unexposed to CATCH. School food service personnel completed questionnaires to assess CATCH guideline implementation, demographic data, behavioral constructs, training, program material use, and participation in competing programs. Five days of menus and recipes were collected from school cafeteria staff, averaged, and compared to USDA School Meal Initiative (SMI) standards. Significant differences between intervention and unexposed schools were found for training and knowledge of CATCH and in mean percentage energy from fat and carbohydrates. Intervention schools most closely met USDA SMI recommendations for fat. Thus, the CATCH Eat Smart Program assisted school cafeterias in meeting USDA guidelines 5 years postimplementation.

Adolescent↗