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Alcoholic beverage choice, risk perception and self-reported drunk driving: effects of measurement on risk analysis.

AIMS: The present study examined effects of measurement on risk curve analysis in an application involving prediction of frequency and indicator measures of drunk driving with beverage-specific alcohol consumption and risk perception measures. DESIGN AND PARTICIPANTS: From a 1995 in-person survey of the US adult household population (response rate = 77%) the responses of 1260 adult drivers who reported any drinking in the prior year were selected for analysis. Regression and graphical techniques were used to investigate relationships between drinking pattern, beverage choice, perception of risks of drinking before driving, and frequency of drunk driving. MEASUREMENTS: Self-reported drunk driving (occurrence) was measured by a question assessing driving after drinking enough to be in trouble if stopped by the police within the prior 12 months; those affirming this (n = 191) were asked how many times they did so (frequency). Alcohol consumption was assessed by beverage and in combination. Risk perception was assessed as a factor score from three correlated measures. Demographic variables included age, ethnicity, education and income. FINDINGS: Controlling for demographics, heavy beer consumption (p < 0.01) more than heavy wine (NS) or liquor/spirits (p < 0.05) intake was strongly predictive of risk perception. A regression analysis showed a significant interaction between heavy beer consumption and perceived risk (p < 0.001) in predicting reported frequency of drunk driving, after controlling for heavy beer consumption (p < 0.05), total alcohol consumption and risk perception (both ps < 0.001). No interactions were important in equivalent models predicting dichotomous occurrence. Graphic analysis showed the shape of the risk curve is altered when frequency of drunk driving is taken into account rather than simple occurrence. CONCLUSIONS: Individuals' underestimation of beer's intoxicating effects, compared to other alcoholic beverage types, helps explain beer's over-representation in drinking driving violation reports. There is a need for creative public health campaigns designed to inform young men of beer's alcohol content and associated risks.

Adult↗

Sex ratio at birth, polygyny, and fertility: a cross-national study.

The sex ratio at birth may reflect frequency of intercourse that affects the timing of conception. If so, cross-national variation in polygyny and fertility might account for country differences in secondary sex ratios. Consistent with the timing of intercourse hypothesis, the birth sex ratios of 148 countries declined with total fertility rates and polygyny intensity, and increased with contraception use in correlational analysis. Regression analysis confirmed that polygyny was a negative predictor of the sex ratio (and contraception was a positive predictor), with level of economic development and mother's age controlled, but the effects disappeared with total fertility added to the equation. The sex ratio evidently declines with increases in fertility because more children are born at a later birth order when frequency of intercourse is lower.

Birth Order↗

Is it possible to reduce AIDS deaths without reinforcing socioeconomic inequalities in health?

BACKGROUND: The wide use of highly active antiretroviral therapy has led to an impressive improvement in AIDS survival after the mid-1990s in cities and countries with a high access to these medications. Notwithstanding its beneficial overall effect, antiretroviral therapy was also reported as a factor for the increase in socioeconomic inequalities in health, because AIDS patients have unequal access and adherence to these medications. METHODS: We assessed trends AIDS mortality in districts of Sao Paulo, Brazil, from 1995 to 2002, in order to test their association with area-level socioeconomic indices in a city with a large-scale and cost-free distribution of highly active antiretroviral therapy. We gathered information on yearly death rates due to AIDS, adjusted for gender, age group, income, instruction, living standards, and the human development index. Trend estimation used the autoregression procedure of exact maximum-likelihood estimation for time-series analysis. Regression analysis was used to study the association between the annual percentage decrease in AIDS deaths and socioeconomic indices. RESULTS: AIDS mortality decreased in Sao Paulo from 32.1 deaths (per 100 000 inhabitants) in 1995 to 11.2 deaths (per 100 000 inhabitants) in 2002. District-level figures of social development did not show an association with the annual percentage decrease in AIDS mortality, with all correlation coefficients corresponding to P-values >0.27. CONCLUSIONS: This observation indicates that the perspective of public policies addressed to the entire population contribute to reducing inequalities in health, while attaining an overall reduction in AIDS deaths, may have been feasible in the Brazilian context.

Acquired Immunodeficiency Syndrome↗

Serum ferritin levels are increased in patients with glomerular diseases and proteinuria.

BACKGROUND: Ferritin is a high molecular weight protein which reflects body iron stores, but may also rise in the case of an acute phase response. Recently, ferritin has been identified as a predictive factor in the development and progression of atherosclerosis. This is the first report on serum ferritin levels in patients with proteinuria. METHODS: We have analysed the data of 142 male patients with a glomerular disease, and proteinuria exceeding 1 g/day. In all patients, we measured various parameters related to proteinuria, serum ferritin and serum iron. Serum beta2-microglobulin and the Modification of Diet in Renal Disease (MDRD) equation were used as measures of the glomerular filtration rate (GFR). RESULTS: Mean age (+/-SD) was 46+/-15 years, MDRD-GFR 57+/-25 ml/min/1.73 m2 and median proteinuria 8.0 g/day [interquartile range (IQR) 3.6-13]. Serum albumin (29+/-9 g/l) and transferrin levels (1.7+/-0.5 g/l) were low, and cholesterol levels were elevated (median 7.3, IQR 5.9-9.5 mmol/l). Median serum ferritin was 148 microg/l (IQR 89-282), and exceeded 280 microg/l, the upper limit of normal, in 36 patients (25%). Elevated serum ferritin levels could not be explained by an acute phase response as determined by C-reactive protein, or haemochromatosis (DNA analysis). Regression analysis showed an independent relationship between ferritin levels and serum cholesterol, GFR and serum transferrin. CONCLUSIONS: Serum ferritin levels are elevated in patients with overt proteinuria. The independent negative relationship between serum ferritin and transferrin points to a specific process and suggests that increased production of ferritin may compensate for the loss of the iron-binding protein transferrin, thus reducing the amount of free iron. Further studies are needed to elucidate the role of ferritin in patients with proteinuria, especially because of the suggested association between ferritin and atherosclerosis.

C-Reactive Protein↗

A limited sampling model for estimation of total and unbound mycophenolic acid (MPA) area under the curve (AUC) in hematopoietic cell transplantation (HCT).

OBJECTIVES: Renal transplant patients with suboptimal mycophenolic acid (MPA) areas under the curves (AUCs) are at greater risk of acute rejection. In hematopoietic cell transplantation, a low MPA AUC is also associated with a higher incidence of acute graft versus host disease. Therefore, a limited sampling model was developed and validated to simultaneously estimate total and unbound MPA AUC0-12 in hematopoietic cell transplantation patients. METHODS: Intensive pharmacokinetic sampling was performed at steady state between days 3 to 7 posttransplant in 73 adult subjects while receiving prophylactic mycophenolate mofetil 1 g per 12 hours orally or intravenously plus cyclosporine. Total and unbound MPA plasma concentrations were measured, and total and unbound AUC0-12 was determined using noncompartmental analysis. Regression analysis was then performed to build IV and PO, total and unbound AUC0-12 models from the first 34 subjects. The predictive performance of these models was tested in the next 39 subjects. RESULTS: Trough concentrations poorly estimate observed total and unbound AUC0-12 (r<0.48). A model with 3 concentrations (2-, 4-, and 6-hour post start of infusion) best estimated observed total and unbound AUC0-12 after IV dosing (r>0.99). Oral total and unbound AUC0-12 was more difficult to estimate and required at least 4 concentrations (0-, 1-, 2-, and 6-hour post dose) in the model (r>0.85). The predictive performance of the final models was good. Eighty-three percent of IV and 70% of PO AUC0-12 predictions fell within +/-20% of the observed values without significant bias. CONCLUSION: Trough MPA concentrations do not accurately describe MPA AUC0-12. Three intravenous (2-, 4-, 6-hour post start of infusion) or 4 oral (0-, 1-, 2-, and 6-hour post dose) MPA plasma concentrations measured over a 12-hour dosing interval will estimate the total and unbound AUC0-12 nearly as well as intensive pharmacokinetic sampling with good precision and low bias. This approach simplifies AUC0-12 targeting of MPA post hematopoietic cell transplantation.

Administration, Oral↗

Impact of the C-N status on the amino acid profile in tobacco source leaves.

This paper investigates the influence of the carbon (C) and nitrogen (N) status on the amino acid profile in tobacco source leaves. Treatments used included growing plants at different light intensities, using an antisense RBCS (small subunit of ribulose-1,5-bisphosphate carboxylase/oxygenase) construct to inhibit Rubisco activity, growing plants on 12 or 0.5 mM nitrate, comparing wild-types with genotypes that have small and large decreases in nitrate reductase (NIA) activity, and sampling plants at different times during the diurnal cycle. This combination of experiments provides information on how amino acid levels respond to several inputs including the C and N status, nitrate, excess light and light-dark transitions. The data set was analysed using principal component analysis, regression analysis and by normalizing the level of each individual amino acid on the total amino acid pool. Most amino acids show a downward trend when the C or the N status is decreased, and rise during day and fall at night during the diurnal cycle. However, individual amino acids often showed deviating responses. Furthermore, no evidence was found for feedback inhibition of minor amino acid synthesis, either within or between pathways, when 18 individual amino acids were supplied to detached leaves. Results indicate that regulation of amino acid metabolism, for example by the C and N status, leads to qualitatively similar responses of many amino acids, but homeostatic mechanisms involving feedback inhibition within or between individual amino acid biosynthesis pathways are not stringent. All of the above inputs affect the level of phenylalanine, an amino acid that is also the substrate for an important sector of secondary metabolism. The levels of glutamate were remarkably constant, indicating that unknown mechanisms stabilize the concentration of this key central amino acid. Analyses of metabolite levels and feeding experiments indicated that 2-oxoglutarate plays an important role in regulating glutamate levels. Glutamate was the most effective inhibitor of NIA activity when 18 individual amino acids were supplied to detached leaves. Feeding glutamate, and other downstream amino acids, led to an increase of glutamine, indicating glutamate exerts feedback regulation on ammonium metabolism.

Amino Acids↗

Efficacy of iron fortification compared to iron supplementation among Vietnamese schoolchildren.

The effect of iron fortification is generally assumed to be less than iron supplementation; however, the magnitude of difference in effects is not known. The present study aims to compare the efficacy of these two strategies on anaemia and iron status. After screening on low Hb, 425 anaemic children in six primary schools in Tam Nong district of Phu Tho province were included in a randomized, placebo-controlled trial comparing two groups receiving iron fortified instant noodles or iron supplementation for 6 months and a control group, with children in all groups having been dewormed. Blood samples were collected before and after intervention for haemoglobin, serum ferritin (SF), serum transferrin receptor (TfR), C-reactive protein (CRP), and haemoglobinopathies analysis. Regression analysis was used to assess the effect of iron fortification and iron supplementation on haemoglobin concentration, SF, TfR, body iron, and anaemic status as outcome variables. The improvement of haemoglobin, SF, and body iron level in the group receiving iron fortification was 42% (2.6 g/L versus 6.2 g/L), 20% (23.5 microg/L versus 117.3 microg/L), and 31.3% (1.4 mg/kg versus 4.4 mg/kg) of that in the iron supplementation group. The prevalence of anaemia dropped to 15.1% in the control group, with an additional reduction of anaemia of 8.5% in the iron supplementation group. The additional reduction due to iron fortification was 5.4%, which amounts to well over 50% of the impact of supplementation. In conclusion, the efficacy of iron fortification based on reduction of prevalence of anaemia, and on the change in haemoglobin level, is about half of the maximum impact of supplementation in case of optimal compliance. Thus, in a population of anaemic children with mild iron deficiency, iron fortification should be the preferred strategy to combat anaemia.

Anemia, Iron-Deficiency↗

Reliability of the Lode Excalibur Sport Ergometer and applicability to Computrainer electromagnetically braked cycling training device.

New technology allows cyclists to train via power output (PO) in addition to heart rate (HR). For those athletes undertaking seasonal laboratory testing (e.g., Vo(2), lactate threshold), it is imperative that athletes be able to directly apply this information to their training device. We examined the reliability of a standardized laboratory ergometer (Lode Excalibur Sport) and its applicability to an electromagnetically braked ergometer (Computrainer) in 2 phases. Phase I (n = 12) examined the reliability of the Lode. Phase II (n = 14) compared the Lode to the Computrainer using a randomized, counterbalance assignment. Following warm-up, each trial started at 100 W, progressing 50 W every 3 minutes to exhaustion. Outcomes were time-to-exhaustion (TTE), peak PO (W) (PO(peak)), peak HR (HR(peak)), and ventilatory (VT) and respiratory compensation (RCP) thresholds. We used a repeated measures analysis of variance (ANOVA), Tukey post hoc analysis, regression analysis, Bland-Altman plots, and coefficient of variation (CV) analysis for each variable. During phase I, we found no significant difference for any variable, minimal dispersion of Vo(2) during Bland-Altman analysis, and a low CV at each test stage (</= 5%). During phase II, significant differences and higher CV for most parameters (all data; p < 0.001) were observed for Lode versus Computrainer: TTE (21 minutes, 12 seconds +/- 3 minutes, 12 seconds vs. 19 minutes, 9 seconds +/- 2 minutes, 36 seconds; CV = 16%), PO(peak) (335 +/- 57.8 W vs. 295 +/- 47.1 W, CV = 17%), as well as PO at VT (CV = 51%) and RCP (CV = 24%; p < 0.01). We conclude that coaches and cyclists may need to use some caution when directly transferring results obtained from laboratory testing to the Computrainer training device.

Bicycling↗

Clinical and familial correlates of tardive dyskinesia in India and Israel.

BACKGROUND: Antipsychotic drugs are widely used for the treatment of psychosis, especially schizophrenia. Their long-term use can result at times in serious side-effects such as Tardive Dyskinesia (TD). Since over 80% of schizophrenia sufferers (lifetime prevalence 1%) receive long-term antipsychotic drug treatment, the extent of the problem is potentially large. Increasing age is the most consistently demonstrated risk factor for TD. AIMS: To assess effect of different clinical factors and demographic variables in India and Israel and sib pair concordance of Tardive Dyskinesia (TD) in India. SETTINGS AND DESIGN: The study was conducted simultaneously among Indian and Israeli subjects: ascertainment was family-based in India and hospital-based in Israel. METHODS AND MATERIAL: In India the instruments used were: Diagnostic Interview for Genetic Studies (DIGS), Positive and Negative Syndrome Scale (PANSS), Abnormal Involuntary Movement Scale (AIMS), and Simpson Angus Scale (SAS). The last three instruments were also used in Israel. STATISTICAL ANALYSIS: Regression analysis and Pearson's correlation. RESULTS AND CONCLUSIONS: TD symptoms were present in 40.4% of 151 Israeli subjects and 28.7% of 334 Indian subjects. While age at onset and total scores on PANSS were significant predictors of TD in both the samples, lower scores on the Global Assessment of Functioning Scale (GAF), diagnostic sub-group and male gender were significant predictors among Indians. There was no concordance of TD symptoms among 33 affected sib-pairs from India.

Adult↗

Association between glycaemic control and quality of life in diabetes mellitus.

BACKGROUND: Relationship between quality of life (QOL) and haemoglobin A1c (HbA1c) amongst diabetics in the community setting is unclear. AIMS: Assess the association between QOL and change in HbA1c in diabetic patients over one year. SETTINGS AND DESIGN: Cohort study of patients from four community clinics in California, USA. METHODS: Diabetic patients identified from databases using International Classification of Disease (ICD-9) codes were asked to complete Short Form 36 (SF-36), which measures health-related QOL, and invited to attend monthly diabetes workshops. From December 2000 to December 2001, data were collected on multiple parameters, including HbA1c. SF-36 surveys were re-collected at project termination. STATISTICAL ANALYSIS: Regression analysis was used to correlate change in HbA1c with change in QOL physical component summary (PCS) and mental component summary (MCS) scores, while considering potential confounders. RESULTS: Of 1679 eligible patients, 380 completed SF-36 at project initiation. 243 of those completed SF-36 at project termination. Pre and post HbA1c data were available for 170 of the 243 who completed SF-36 at both times. Average MCS increased by 8.46% and PCS decreased by 2.24%. After adjustment, a 5% decrease in HbA1c values was associated with a 1% increase in MCS. No association between changes in HbA1c and PCS was observed. CONCLUSIONS: Association between better HbA1c and improved mental, but not physical, QOL may reflect physical inconvenience of increased regimen complexity and mental empowerment from proactive disease management. Larger cohort studies with longer follow-up are needed to further elucidate the relationship between glycemic control and QOL.

Cohort Studies↗

Cerebrospinal fluid variables in clinically normal foals from birth to 42 days of age.

To determine the effects of age on each analyte, CSF variables were evaluated in healthy foals from birth through 42 days of age. Cerebrospinal fluid was collected from 14 clinically normal, naturally delivered cross-bred foals and was analyzed for glucose, sodium, potassium, magnesium, and total protein concentrations, total and differential WBC counts, RBC count, and lactate dehydrogenase, aspartate transaminase, and creatine kinase activities. Samples were collected in 3 foals < 48 hours old, and at 11 to 14 days of age in 4 foals, 21 to 22 days of age in 3 foals, and 31 to 42 days of age in 4 foals. Each foal was tested only once, to avoid any effects of CSF sample collection on subsequent analysis. Regression analysis confirmed age-related effects on CSF glucose, protein, and magnesium concentrations, but did not indicate an effect of age on CSF sodium and potassium concentrations or cell counts. Results indicate that CSF glucose concentration decreases with age; foals < 2 days old had the highest CSF glucose values, 98.8 +/- 12.0 mg/dl (mean +/- 1 SD). In foals 10 to 14 days old, CSF glucose concentration was 67.3 +/- 12.0 mg/dl, was 65.3 +/- 4.5 mg/dl in foals 21 to 22 days old, was 70.0 +/- 5.4 mg/dl in foals 31 to 42 days old, and was 51.1 +/- 2.5 mg/dl in adults.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

[Comparative studies of morphometric and functional results following reconstruction of motor nerves].

In order to determine the value of a reconstructive procedure in the peripheral nerve, experimental studies often evaluate the number and the diameter of myelinated nerve fibers as a parameter for the quality of regeneration. This study addresses the correlation between the number of fibers in a peripheral motor nerve after microsurgical reconstruction and the functional result, expressed as the force of the reinnervated muscle. In a total number of 24 sheep, the motor branch to the rectus femoris muscle was severed. The muscle was reinnervated either by direct neurorrhaphy or by nerve grafting, performed in three different ways (free grafting to the ipsilateral muscle, free grafting to the contralateral muscle, vascularized grafting to the ipsilateral muscle). In the final experiments, the muscle force in the reinnervated muscle was determined by supramaximal electrical stimulation. Number and diameter of myelinated nerve fibers were evaluated by computer-assisted morphometric analysis. Regression analysis of morphometric data and the muscle forces was calculated. No correlation was found between fiber numbers in the nerve graft and the maximal force. However, a positive correlation between the number of myelinated fibers in the motor branch distal to the site of coaptation and the functional result was observed in some cases. The diameter of myelinated fibers had no influence on the functional outcome.

Animals↗

A study of home deaths in Japan from 1951 to 2002.

BACKGROUND: Several surveys in Japan have indicated that most terminally ill Japanese patients would prefer to die at home or in a homelike setting. However, there is a great disparity between this stated preference and the reality, since most Japanese die in hospital. We report here national changes in home deaths in Japan over the last 5 decades. Using prefecture data, we also examined the factors in the medical service associated with home death in Japan. METHODS: Published data on place of death was obtained from the vital statistics compiled by the Ministry of Health, Labor and Welfare of Japan. We analyzed trends of home deaths from 1951 to 2002, and describe the changes in the proportion of home deaths by region, sex, age, and cause of death. Joinpoint regression analysis was used for trend analysis. Logistic regression analysis was performed to identify secular trends in home deaths, and the impact of age, sex, year of deaths and cause of deaths on home death. We also examined the association between home death and medical service factors by multiple regression analysis, using home death rate by prefectures in 2002 as a dependent variable. RESULTS: A significant decrease in the percentage of patients dying at home was observed in the results of joinpoint regression analysis. Older patients and males were more likely to die at home. Patients who died from cancer were less likely to die at home. The results of multiple regression analysis indicated that home death was related to the number of beds in hospital, ratio of daily occupied beds in general hospital, the number of families in which the elderly were living alone, and dwelling rooms. CONCLUSION: The pattern of the place of death has not only been determined by social and demographic characteristics of the decedent, but also associated with the medical service in the community.

Journal Article↗

Prognostic factors for short-term survival in alcoholic hepatitis in Japan: analysis by logistic regression.

Prognostic factors for the outcome of patients with alcoholic hepatitis were identified by logistic regression analysis. To predict the outcome immediately after admission, clinical data from 97 patients with alcoholic hepatitis on admission were introduced to multivariate analysis. Independent prognostic factors for favorable outcome were hepaplastin time, peripheral white blood cell count, age (40 to 60 years), and serum creatinine level (below 1.4 mg/dl). Sensitivity, specificity, positive predictive value, negative predictive value, and predictive accuracy were 0.78, 0.89, 0.78, 0.89, and 0.86, respectively. The resultant equation for the death rate was applied to another set of patients with alcoholic hepatitis as a validation study. Predictive accuracy estimated 0.95 in validation. The prognostic index derived was simple, accurate, and useful in the prediction of the outcome in patients with alcoholic hepatitis. Furthermore, it provides the clinician with an indication of the necessity for the intensive care of patients in a critical condition.

Adult↗

Ruptured abdominal aortic aneurysm: six-year follow-up results of a multicenter prospective study. Canadian Society for Vascular Surgery Aneurysm Study Group.

PURPOSE: On the basis of a prospective analysis of 147 patients undergoing surgery for ruptured abdominal aortic aneurysm (AAA) and recorded in the Canadian Society for Vascular Surgery Aneurysm Registry, this study defines the early and 6-year actuarial survival rates and determines the predictive variables that are associated with survival. METHODS: Ongoing follow-up of a cohort of patients was current at the time of analysis. To identify the preoperative, intraoperative, and postoperative variables that were associated with survival, statistical methods included chi-squared analysis, logistic regression analysis, Kaplan-Meier analysis, and Cox regression analysis. RESULTS: The survival rate was 48.6% at 1 month, 34.7% +/- 4.2% at 3 years, and 22.0% +/- 4.0% at 6 years. When preoperative and intraoperative variables were considered and logistic regression analysis was used, the highest probability of early in-hospital survival was associated with preoperative creatinine levels of 1.3 mg/dl or less, intraoperative urine output of 200 ml or greater, and infrarenal clamp site. The highest probability of late survival, as calculated by the Cox proportional hazards method, was predicted by the patient's age and total urine output during the procedure. When all variables, including postoperative complications, were considered, late survival was highest if intraoperative urine output was 200 ml or greater and respiratory failure and myocardial infarction did not occur. For those patients with ruptured AAA who survived operation (i.e., greater than 1 month), the long-term survival rate was significantly lower than a comparable group undergoing repair of nonruptured AAA. CONCLUSIONS: Patients who survive repair of a ruptured AAA have a lower late survival rate than patients undergoing elective repair. When a patient is evaluated before operation, no combination of preoperative variables could identify those patients with little or no chance of survival; hence, the decision to repair a ruptured AAA should be made on clinical grounds. However, after surgery (when information on intraoperative and postoperative variables is also available), the results of this study provide a basis for the surgeon to use these prognostic variables to assist clinical judgment and guide discussions on prognosis with the family and to identify those patients who have such a low chance of early and late survival that further aggressive treatment may be futile.

Aged↗

[Relationship between growth of young children and complementary feeding].

Description analysis, correlation regression analysis and logistic regression analysis were applied to evaluate the impact of complementary food on the growth of children from the aged 4 to 24 months, results on the effect of the complementary feeding were presented. Among children under 2 years in poor rural areas, 42% of them got complementary food containing animal food, 30.5% got milk, 57.8% got starchy foods, and 48.6% got vegetables and fruits. The coverage of complementary food containing animal food, vegetables/fruits was only half of that in the urban areas. Analysis revealed significantly positive correlation of HAZ, WAZ of all age group of children under 2 years with the appearance of animal foods, vegetable and fruit in the complementary food, but there was no significantly correlation with starchy foods. According to the regression coefficient, it was estimated that the prevalence of stunting aged 18-24 months could be reduced 2.6 percentage points if 10% increase of coverage of animal food containing complementary food in the CFNSS site was achieved. Logistic regression analysis showed the odds ratio (OR) of non-animal food complementary food for stunting was 2.21 for children aged 4-6 months, 1.73 for 6-12 months, 2.81 for 12-18 months, 2.58 for 18-24 months, OR for underweight was 2.87 for 12-18 months, and 2.08 for 18-24 months.

Child Development↗

Maternal acceptability of a dietary intervention designed to lower children's intake of saturated fat and cholesterol: the Dietary Intervention Study in Children (DISC).

OBJECTIVE: This report examined the acceptability to mothers of a dietary educational and behavioral intervention for preadolescent children with elevated levels of serum low-density lipoprotein cholesterol (LDL-C) who were enrolled in the Dietary Intervention Study in Children (DISC). DESIGN: DISC is a randomized, controlled clinical trial. Subjects were randomly assigned to either an intervention or usual-care (control) group. SUBJECTS/SETTING: To be eligible for the study, participants were required to have the average of 2 fasting LDL-C values fall between the 80th and 98th sex-specific percentiles. Three hundred thirty-four 8-to 10-year-old children and their families were randomly assigned to an intervention group, and 329 were assigned to a usual-care (control) group. This study examined data from 232 subjects in the intervention group. Data were collected at 6 intervention sites around the United States. INTERVENTION: Those assigned to the intervention group participated in a multidisciplinary dietary intervention that included a series of group and individual sessions over a 3-year period. Children and their caretakers were taught to follow a nutritionally adequate diet that was low in total fat, saturated fat, and cholesterol and high in polyunsaturated fat. MAIN OUTCOME MEASURES: Three nonconsecutive 24-hour diet recalls were collected at baseline and at 1 year by trained and certified dietitians. A questionnaire designed to assess diet acceptability was administered at months 4, 8, 11, and 15. Demographic measures were collected at the onset of the study. STATISTICAL ANALYSIS PERFORMED: Statistical procedures included factor analysis and regression analysis. RESULTS: Regression analysis suggested that perceived effectiveness of the dietary intervention and mothers' having few concerns about disadvantages of the diet were significantly related to higher overall fat intake in children in one-parent families. Maternal willingness to implement the diet was significantly related to lower saturated fat intake. APPLICATIONS/CONCLUSIONS: In attempts to change eating behavior of children, interest and cooperation of the parents are essential to achieving successful results. These analyses further suggest that maternal acceptability translates into willingness to implement the diet and may facilitate changes that are associated with reduced saturated fat intake in children.

Child↗

Abdominal fat distribution and coronary heart disease risk factors in men-waist/height ratio as a simple and useful predictor.

OBJECTIVE: To determine whether waist/height ratio is a useful predictor for coronary heart disease (CHD) risk factors in men. DESIGN: An epidemiologic study comparing relationships between waist/height ratio, body mass index, waist/hip ratio and CHD risk factor levels [continuous variables--systolic and dialostic blood pressure, fasting blood glucose, hemoglobin A1c (HbA1c), triglyceride, cholesterol, HDL cholesterol values] and the risk factor morbidity index (sum of the risk factor scores for hypertension, abnormal glucose tolerance, hypertriglyceridemia, hypercholesterolemia and low HDL cholesterol--one point each if present). SETTING: A health examination facility within a general hospital. SUBJECTS: 3131 men underwent routine health examination. RESULTS: Body mass index, waist/hip ratio and waist/height ratio were significantly associated with all of the risk factor levels and with the risk factor morbidity index according to the result of simple regression analysis. Multiple regression analysis for waist/hip ratio and body mass index showed that both of them were also significantly associated with all of the risk factor levels and with the risk factor morbidity index, except HbA1c levels with body mass index. According to the results of multiple regression analysis for waist/height ratio and body mass index, body mass index was not significantly associated with fasting blood glucose, HbA1c, cholesterol levels or the risk factor morbidity index whereas waist/height ratio was significantly associated with all of the variables. On the other hand, while waist/height ratio was significantly associated with all of the variables, waist/hip ratio was not significantly associated with most of the variables when waist/height ratio and waist/hip ratio were compared. CONCLUSION: Waist/height ratio, an index of abdominal obesity, may be a better predictor of multiple CHD risk factors in men than waist/hip ratio in mass epidemiologic studies.

Abdomen↗