Whole-Grain Intake Correlates among Adolescents and Young Adults: Findings from Project EAT

Background

National survey data indicate few adolescents or young adults consume whole grains in the amount recommended to prevent chronic disease and maintain a healthful weight. Interventions are needed to address this gap; however, little is known about what modifiable factors influence whole-grain intake among youth.

Objective

This study aimed to identify socioenvironmental, personal, and behavioral correlates of whole-grain intake among adolescents and young adults.

Design

Data for this cross-sectional analysis were drawn from Project EAT (Eating Among Teens)-II, the second wave of a population-based study in Minnesota. Mailed surveys and food frequency questionnaires were completed by male (44.8%) and female (55.2%) participants in 2003-2004, including 792 adolescents (mean age=17.2 years) and 1,686 young adults (mean age=20.5 years). Linear regression models adjusted for demographic characteristics were used to identify factors associated with energy-adjusted daily intake of whole grains.

Results

Mean daily intake of whole grains was lower than recommended among adolescents (males: 0.59±0.04 servings, females: 0.61±0.04 servings) and young adults (males: 0.68±0.03 servings, females: 0.58±0.03 servings). Home availability of whole-grain bread, self-efficacy to consume ≥3 daily servings of whole grains, and preference for the taste of whole-grain bread were positively associated with whole-grain intake during adolescence and young adulthood across sex. Conversely, fast-food intake was associated with lower intake of whole grains among adolescents and young adults of both sexes. The factors examined in this study explained 28% to 34% of variance in whole-grain intake across sex and the two age groups.

Conclusions

The findings suggest nutrition interventions should address the availability of whole-grain foods in homes and restaurants. In addition, young people should be provided with opportunities to taste a variety of whole-grain foods to enhance taste preferences and self-efficacy to consume whole-grain products.     

Fruit and vegetable intake among rural youth following a school-based randomized controlled trial

Objective

We implemented a theory-based randomized controlled trial (Living Free of Tobacco, Plus (LIFT +) in ten rural middle schools and assessed impact on tobacco use and fruit/vegetable (F/V) intake in 2008-2010. Data on F/V intake at baseline, immediate post intervention, and 1-year follow-up are presented.

Methods

Schools were randomized to intervention or control groups. Goal setting, peer leaders, and class workshops with parent involvement, were intervention features; community partners were supportive. Seventh graders filled out surveys on health behaviors, psycho-social variables, and demographic characteristics. Adjusted models comparing intervention and control conditions were analyzed.

Results

Sample (n = 1119) was 48.5% female, 50% White, with a mean age of 12.7 years. Mean F/V servings were significantly higher in intervention schools at immediate post (3.19 servings) and at 1-year (3.02 servings) compared to controls (2.90, 2.69 respectively). Knowledge of 5-a-day recommendation was significantly higher in intervention schools at immediate post test (75.0%) versus controls (53.8%) but not at 1-year follow-up.

Conclusions

Intervention schools reported significantly higher mean F/V servings at post intervention and 1-year, and for knowledge of F/V recommendations at immediate post compared to controls. Higher levels of parent and community involvement may further increase F/V intake in future interventions.ClinicalTrials.gov Identifier: NCT01412697.     

Health-At-Every-Size and Eating Behaviors: 1-Year Follow-Up Results of a Size Acceptance Intervention

Background

Poor long-term success observed with current weight-control strategies stresses the relevance to explore new weight management approaches.

Objective

To assess the effects of a Health-At-Every-Size (HAES) intervention on eating behaviors, appetite sensations, metabolic and anthropometric variables, and physical activity levels in women at 6-month and 1-year postintervention.

Design

Randomized controlled trial; measurements at baseline, at the end of the intervention period (4 months), and at 6-month and 1-year postintervention (10 months and 16 months, respectively). Intervention and testing took place from September 2003 to August 2006.

Participants/setting

Premenopausal overweight/obese women (n=144; mean age of 42.3±5.6 years), recruited from free-living, general community.

Intervention

Women were randomly assigned to: HAES group (n=48), social support group (n=48), or control group (n=48).

Main outcome measures

Eating behaviors (restraint, disinhibition, and susceptibility to hunger), appetite ratings (desire to eat, hunger, fullness, and prospective food consumption), anthropometric and metabolic variables (body mass index, waist and hip circumferences, blood lipid levels, and blood pressure), and engagement in moderate to intense physical activity (energy cost ≥1.2 kcal×kg⁻¹×15 minutes⁻¹ [≥4.8 metabolic equivalents]).

Statistical analyses performed

Changes for each dependent variable were assessed by linear mixed models according to a group (HAES vs social support vs control) by time (baseline vs 4 months vs 10 months vs 16 months) split-plot design.

Results

Situational susceptibility to disinhibition and susceptibility to hunger significantly decreased over time in both HAES group (−0.9±0.2 and −1.3±0.5, respectively) and the social support group (−0.4± 0.2 and −1.4±0.5, respectively). Although eating behavior scores observed at 16 months did not differ between HAES and social support groups (situational susceptibility to disinhibition: 2.5±0.2 in HAES group vs 2.7 ± 0.2 in social support group; susceptibility to hunger: 4.2±0.5 in both groups), they were lower in these groups than scores noted in the control group (3.3±0.2 for situational susceptibility to disinhibition and 5.9±0.5 for susceptibility to hunger).

Conclusions

These results suggest that, when compared to a control group, an HAES approach could have long-term beneficial effects on eating behaviors related to disinhibition and hunger. In addition, our study did not show distinctive effects of the HAES approach in comparison to a social support intervention.     

Whole-Grain Consumption Is Associated with Diet Quality and Nutrient Intake in Adults: The National Health and Nutrition Examination Survey, 1999-2004

Background

The consumption of whole grains and its association with nutrient intake has not been assessed in a recent nationally representative population.

Objective

To examine the association of consumption of whole grains, using the new whole-grain definition, with diet quality and nutrient intake in a recent, nationally representative sample of adults.

Design

Secondary analysis of cross-sectional data from 1999-2004 National Health and Nutrition Examination Survey.

Participants and methods

Adults aged 19 to 50 years (n=7,039) and aged 51 years and older (n=6,237).

Main outcome measures

Participants were divided into four whole-grain consumption groups: ≤0 to <0.6, ≥0.6 to <1.5, ≥1.5 to <3.0, and ≥3.0 servings (ounce equivalents)/day. Macro- and micronutrient intakes and diet quality, using the Healthy Eating Index, were determined for each group.

Statistical analyses

Sample weights were applied. The percentages of adults in whole-grain consumption groups were calculated. The covariates used were energy, ethnicity, sex, and age. Least-square means were calculated. P for linear trend analysis was determined using whole-grain intake as a linear covariate. A P value of ≤0.05 was considered significant.

Results

Adults aged 19 to 50 and 51+ years consumed a mean of 0.63 and 0.77 servings of whole grains per day, respectively. For both age groups, diet quality and intake of energy, fiber, and polyunsaturated fatty acids were significantly higher in those consuming the most servings of whole grains. Intake of total sugars (19 to 50 year age group only), added sugars, saturated fatty acids, monounsaturated fatty acids, and cholesterol was significantly lower in those consuming the most servings of whole grains. Intake of all micronutrients, except vitamin B-12 and sodium, was higher among individuals who consumed the most servings of whole grains.

Conclusions

Overall consumption of whole grains in the US population was low using the recently updated whole-grain definition. Adults who consumed the most servings of whole grains had better diet quality and nutrient intakes.     

The Medicine Wheel Nutrition Intervention: A Diabetes Education Study with the Cheyenne River Sioux Tribe

Objective

The Northern Plains Indians of the Cheyenne River Sioux Tribe have experienced significant lifestyle and dietary changes over the past seven generations that have resulted in increased rates of diabetes and obesity. The objective of this study was to determine if Northern Plains Indians with type 2 diabetes mellitus who are randomized to receive culturally adapted educational lessons based on the Medicine Wheel Model for Nutrition in addition to their usual dietary education will have better control of their type 2 diabetes than a nonintervention, usual care group who received only the usual dietary education from their personal providers.

Design

A 6-month, randomized, controlled trial was conducted January 2005 through December 2005, with participants randomized to the education intervention or usual care control group. The education group received six nutrition lessons based on the Medicine Wheel Model for Nutrition. The usual care group received the usual dietary education from their personal providers.

Participants

One hundred fourteen Northern Plains Indians from Cheyenne River Sioux Tribe aged 18 to 65 years, with type 2 diabetes.

Methods

Weight, body mass index (BMI), hemoglobin A1c, fasting serum glucose and lipid parameters, circulating insulin, and blood pressure were measured at the beginning and completion. Diet histories, physical activity, and dietary satiety surveys were measured at baseline and monthly through completion. Differences were determined using Student t tests, χ² tests, and analysis of variance.

Results

The education group had a significant weight loss (1.4±0.4 kg, P≤0.05) and decrease in BMI (1.0±0.1, P≤0.05) from baseline to completion. The usual care group had no change in weight (0.5±0.5 kg) or BMI (0.5±0.2). There were no between group differences due to intervention in energy, carbohydrate, protein, and fat intake and physical activity.

Conclusions

The culturally based nutrition intervention promoted small but positive changes in weight. Greater frequency and longer duration of educational support may be needed to influence blood glucose and lipid parameters.     

Vaginal vs. sublingual misoprostol with mifepristone for cervical priming in second-trimester abortion by dilation and evacuation: a randomized clinical trial

Objectives

The study was conducted to assess the effectiveness of mifepristone 200 mg 48 h before administering misoprostol 600 μg, sublingual vs. vaginal route, prior to dilation and evacuation (D&E) in 12- to 20-week pregnancies.

Design

Randomized clinical trial.

Setting

Clínica Mediterrania Médica, Valencia, Spain.

Subjects

Women with 12- to 20-week pregnancies wanting a voluntary abortion between July 9, 2004, and February 9, 2006.

Methods

Nine hundred women were randomized to be included in one of the following four groups: (I) mifepristone 200 mg plus sublingual misoprostol 600 μg before D&E, (II) mifepristone 200 mg plus vaginal misoprostol 600 μg before D&E, (III) sublingual misoprostol 600 μg before D&E and (IV) vaginal misoprostol 600 μg before D&E.

Main Outcomes Measured

The degree of cervical dilation achieved before D&E, surgical time necessary to terminate the pregnancy and side effects of misoprostol.

Results

The average cervical dilation in the mifepristone groups was 12.5±2.8 mm (SD) [95% confidence interval (CI), 12.3-12.8] vs. 8.5±3.2 mm (SD) (95% CI, 8.2-8.8) in those receiving only misoprostol. Surgical time in the mifepristone sublingual misoprostol group was 11.9±4.3 min (SD) vs. 13.0±5.3 min (SD) in the sublingual misoprostol group without mifepristone (p=.007); in the mifepristone vaginal misoprostol group, the average surgical time was 12.3±5.0 min (SD) vs. 13.0±6.2 (SD) in the vaginal misoprostol group without mifepristone (p=.031).

Conclusions

Administering mifepristone before D&E with misoprostol in second-trimester abortions makes surgery easier and shorter and, to a certain extent, lessens the risk of cervical injuries, especially in D&E in advanced gestational periods.     

Parent participation in weight-related health interventions for children and adolescents: a systematic review and meta-analysis

Objective

To review child and adolescent weight-related health intervention characteristics, with a particular focus on levels of parental participation, and examine differences in intervention effectiveness.

Methods

Multiple social science, health, and medical databases were searched, and experimental randomized controlled studies of child and adolescent weight‐related health interventions, reported in January 2004 through December 2010, were collected. Intervention characteristics were reviewed, and pre- and post-measurement data, including body mass index, were extracted for analyses. Differences in effect sizes of experimental and control groups were used to evaluate effectiveness of interventions.

Results

Reports of 42 interventions were included. Intervention activities consisted of nutrition education, physical activity education, physical activity sessions, behavior education, behavior therapy, or a combination of these activities. Significant differences existed among levels of parent participation, p < 0.05. In addition, intervention duration positively predicted intervention effectiveness, p = 0.006, and the linear combination of parent participation and intervention duration significantly predicted intervention effectiveness, p = 0.001.

Conclusions

This study suggests that weight‐related health interventions that require parent participation more effectively reduce body mass indexes of child and adolescent participants. In addition, longer interventions that include parent participation appear to have greater success. Suggestions for future research and related interventions are provided.     

Higher Healthy Eating Index-2005 Scores Associated with Reduced Symptoms of Depression in an Urban Population: Findings from the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) Study

Background

Depression affects more than 15 million Americans in a given year. Compared to physical health, less is known about the affect of diet quality on symptoms of depression.

Objective

This study investigated the relationship between diet quality and reported symptoms of depression in a low-income urban population.

Subjects/setting

Subjects included 1,118 African-American and white adults, aged 30 to 64 years, living in Baltimore, MD, and represented a subsample of the initial examination and recruitment phase of the Healthy Aging in Neighborhoods of Diversity across the Life Span study.

Methods

Nutrition data were based on two 24-hour dietary recalls collected by trained interviewers using the US Department of Agriculture Automated Multiple Pass Method. Diet quality was calculated using the US Department of Agriculture Healthy Eating Index (HEI)-2005. Depressive symptoms were assessed by a trained interviewer using the Center for Epidemiologic Studies Depression scale.

Statistical analysis

Both linear and logistic regression analyses were used to examine whether or not diet quality was associated with depressive symptoms. The dependent variable was depressive symptoms and independent variables included HEI-2005, race, sex, age, education, income, and food-assistance program participation.

Results

Mean HEI-2005 score was 52.17±0.40 (out of 100). Mean Center for Epidemiologic Studies Depression scale score was 11.64±0.25 (out of 40). Diet quality was significantly associated with reported symptoms of depression. However, income was a significantly stronger predictor of depression compared to diet quality, education, and sex.

Conclusions

Registered dietitians should be aware of relationships between psychological status and nutritional health when assisting clients to better manage their food choices to improve their overall health and quality of life.     

Predictors of Dietary Change and Maintenance in the Women’s Health Initiative Dietary Modification Trial

Objective

To identify predictors of dietary change to and maintenance of a low-fat eating pattern (<20% energy from fat, ≥5 servings fruits/vegetables daily, and ≥6 servings grains daily) among a cohort of postmenopausal women. Candidate predictors included intrapersonal, interpersonal, intervention program characteristics, and clinical center.

Design

Longitudinal study within the Women’s Health Initiative Dietary Modification Trial. Dietary change was evaluated after 1 year of participation in the Women’s Health Initiative Dietary Modification Trial, and dietary maintenance after 3 years.

Subjects

Postmenopausal women aged 50 to 79 years at baseline who were randomized to the intervention arm of the Women’s Health Initiative Dietary Modification Trial (n=19,541).

Statistical analysis

Univariate and multivariate linear regression analysis was performed and associations evaluated between candidate predictors and each of the three dietary goals: percent energy from fat, fruit/vegetable servings, and grain servings.

Results

Year 1 (change) predictors of percent energy from fat (P<0.005) included being younger (β=2.12; 70 to 79 years vs 50 to 59 years), more educated (β=-.69; college vs high school), more optimistic (β=-.07), attending more sessions (β=-.69), and submitting more self-monitoring records (β=-.74). At year 3 (maintenance), the predictors of percent energy from fat (P<0.005) included attending more sessions (β=-.65) and submitting more self-monitoring scores (β=-.71). The analytic model predicted 22% of the variance in fat intake at year 1 and 27% at year 3 (P<0.01).

Conclusions

The strongest predictors of dietary change and maintenance were attending intervention sessions and self-monitoring dietary intake. Novel was the finding that optimism predicted dietary change.     

Soy protein retards the progression of non-alcoholic steatohepatitis via improvement of insulin resistance and steatosis

Objective

Non-alcoholic steatohepatitis (NASH) is a common cause of liver disease, and it may progress to fibrosis or cirrhosis. The aim of this study was to investigate the effects of soy protein on hepatic steatosis and insulin resistance in NASH.

Methods

Forty male Sprague-Dawley rats were fed a high-fat diet for 4 wk to induce NASH and then were allocated to one of four diets: a NASH-inducing diet, a standard diet, a NASH-inducing diet plus soy protein, and a standard diet plus soy protein.

Results

After the 10-wk experimental period, the results showed that soy protein significantly lowered plasma cholesterol concentrations and body fat accumulation. Soy protein intake also decreased the hepatic lipid depots of triacylglycerols and cholesterol and decreased the concentrations of lipid peroxides. In an analysis of antioxidative status, rats fed the soy protein diet showed improved antioxidative potential due to increases in superoxide dismutase and catalase activities and a decrease in the protein expression of cytochrome P450 2E1.

Conclusion

Soy protein may improve the liver function in patients with NASH by lowering lipid levels in the blood and liver, increasing the antioxidative capacity, and improving insulin resistance.     

Dietary Intakes and Physical Activity among Preschool-Aged Children Living in Rural American Indian Communities before a Family-Based Healthy Lifestyle Intervention

Objective

To report dietary intake and physical activity among preschool-aged children living in rural American Indian communities before participation in a family-based healthy lifestyle intervention and to compare data to current age-specific recommendations.

Subjects/design

One hundred thirty-five preschool-aged children, living in rural American Indian communities, provided diet and physical activity data before participating in a 2-year randomized healthy lifestyle intervention. Three 24-hour dietary recalls assessed nutrient and food and added sugar intake, which were compared to the National Academy of Science's Dietary Reference Intakes, the US Department of Agriculture's MyPyramid, and American Heart Association recommendations. Time watching television and moderate plus vigorous activity was compared to MyPyramid and American Academy of Pediatrics recommendations.

Statistical analysis

Nutrient, food group, added sugar intake, and time watching television and in moderate or vigorous activity were compared to recommendations by computing the percent of recommendations met. Nonparametric tests identified differences in diet and physical activity among age groups and normal and overweight children (body mass index <85th and ≥85th percentile).

Results

Average nutrient intakes met recommendations whereas food group intakes did not. Mean fruit and vegetable intakes for 2- to 3-year-olds were 0.36 c/day fruit and 0.45 c/day vegetables and, for 4- to 5-year-olds, 0.33 c/day fruit and 0.48 c/day vegetables. Both age groups reported consuming more than 50 g added sugar, exceeding the recommendation of 16 g. Overweight vs normal weight children reported significantly more sweetened beverage intake (8.0±0.10 vs 5.28±0.08 oz/day, P<0.01). On average, all children reported watching television 2.0 hours/day and significant differences were observed for total television viewing and nonviewing time between overweight and normal weight children (8.52±0.6 vs 6.54±0.6 hours/day, P<0.01). All children engaged in <20 minutes/day of moderate or vigorous activity.

Conclusions

Overall, children in this sample did not meet MyPyramid recommendations for fruits or vegetables and exceed added sugar intake recommendations. Television viewing time and time when the television was on in the home was highly prevalent along with low levels of moderate or vigorous activity. The Healthy Children Strong Families intervention we studied has potential for improving nutrition and physical activity among preschool-aged children living in rural American Indian communities.     

Immunogenicity and safety of inactivated monovalent 2009 H1N1 influenza A vaccine in immunocompromised children and young adults

Background

Influenza vaccination is recommended for immunocompromised patients.

Methods

Children (6 months to 21 years) with cancer, HIV infection, or sickle cell disease (SCD) received 1 or 2 doses of pandemic 2009 H1N1 monovalent influenza vaccine (H1N1 MIV). Safety and tolerability, hemagglutination inhibition (HI) and microneutralization (MN) antibody titers were measured against 2009 H1N1 influenza A virus after each dose. Seroprotection (SP) and seroconversion (SC) rates were determined.

Results

103 participants were enrolled and 99 were evaluable (39 with HIV, 37 with cancer and 23 with SCD). Mean age (±SD) was 7.9 (±5.4) years for cancer participants, 18.0 (±3.5) for HIV, and 13.3 (±4.2) for SCD. 54% were males; 65% black; and 96% had received seasonal influenza vaccine. HIV-infected participants had a median CD4 count of 625 cells/mm³ (range, 140-1260). 46% had an undetectable HIV viral load and 41% were perinatally infected. No participant had vaccine-related serious adverse events. None developed influenza A proven illness during the 6 months after the vaccine. Local injection reactions were reported in 29% and systemic reactions in 42% after the first dose of vaccine. SC and SP were achieved after the last dose in 48% and 52%, respectively, of participants with leukemia or lymphoma, 50% and 75% of participants with solid tumors, 63% and 92% of HIV-infected participants, and 74% and 100% of participants with SCD.

Conclusion

H1N1 MIV was safe and well tolerated. H1N1 MIV resulted in an adequate immune response in children with SCD. It was only modestly immunogenic in cancer or HIV participants.     

Antibiotic susceptibility of Salmonella enterica serovar Typhi isolated from blood cultures at the Ain M'lila hospital (Algeria), between 2005 and 2008

Introduction

Typhoid fever is a food- and water-borne disease, caused by Salmonella enterica serovar Typhi, responsible for high rates of morbidity and mortality in developing countries. Typhoid is also a public health problem in Algeria. Antimicrobial susceptibility surveillance must be applied to prevent the emergence of multidrug resistant strains.

Patients and methods

We studied the incidence of S. enterica serovar Typhi isolated from blood cultures in the Ain M’lila public hospital (Algeria), between 2005 and 2008. Blood cultures were performed in the febrile stage of infection and positive samples were identified by biochemical and antigenic tests. Susceptibility to ampicillin, cotrimoxazole, chloramphenicol and nalidixic acid was tested by antibiogram.

Results

One hundred and seventy-eight strains were isolated from blood cultures between 2005 and 2008. They were all susceptible to the antibiotics tested.

Discussion

Typhoid fever incidence has decreased in Algeria. In our region, it comes by outbreaks during the summer season, with no sporadic cases between the peaks. In our study, S. enterica serovar Typhi was still susceptible to antimicrobials despite the worldwide emergence of multidrug resistant strains.

Conclusion

A regular surveillance of Salmonella typhi antibiotic susceptibility is mandatory.     

Perceived competence and contraceptive use during adolescence

Background

Little is known about psychosocial correlates of different contraceptive methods in adolescence.

Study Design

Cross-sectional analyses of 209 postmenarcheal girls [mean age (years)±SD=15.68±1.74], primarily Caucasian (62.8%) or African American (32.8%). Competence (activities and social) and rule-breaking behavior were assessed by the Youth Self Report (YSR; adolescent) and the Child Behavior Checklist (CBCL; parent). Three contraceptive-use groups were created: no hormonal contraceptive (n=142), combined oral contraceptives or the transdermal patch (COCs/patch, n=41), and depot medroxyprogesterone acetate (DMPA, n=20).

Results

There was a significant effect of contraceptive-use group on competence (p=.003). The DMPA group had lower competence (CBCL activities and social; YSR social) than the no-hormonal-contraceptive and COCs/patch groups. The COCs/patch group scored lower than the no-hormonal-contraceptive group on YSR activities competence, but was not different from the DMPA group. Lastly, there was an effect of contraceptive-use group on CBCL (but not YSR) rule-breaking behavior (p=.029) with the DMPA group having higher rule-breaking behavior than the other groups.

Conclusions

Type of contraceptive method was associated with parent and adolescent's perceived competence. For rule-breaking behavior, parental perception may be more relevant to contraceptive use.     

Decaying behavioral effects in a randomized, multi-year fruit and vegetable intake intervention

Objective

To examine the effects of a multi-component, theory-based, 2.5-year intervention on children's fruit and vegetable consumption, preferences, knowledge and body mass index.

Methods

Four inner city elementary schools in the Northeastern United States were randomized to an intervention (n = 149) or control group (n = 148) in 2005. Fruit and vegetable consumption during school lunch (measured by plate waste), preferences, and knowledge, as well as body mass index, were assessed five times across 3.5 years (pre-intervention, spring 2006, 2007, 2008 and 2009). Hierarchical linear modeling was used to analyze program outcomes.

Results

At the first post-test assessment, children in the experimental group ate 0.28 more servings/lunch of fruit and vegetable relative to children in the control group and changes in fruit and vegetable consumption were found in each year throughout the program. However, this effect declined steadily across time so that by the delayed one-year follow-up period there was no difference between the groups in fruit and vegetable consumption. There were persistent intervention effects on children's knowledge. There were no effects on fruit and vegetable preferences and body mass index throughout the study.

Conclusion

Although there was initial fruit and vegetable behavior change, annual measurements indicated a gradual decay of behavioral effects. These data have implications for the design of school-based fruit and vegetable interventions.     

Do instructions for over-the-counter pre-coital female contraceptives promote “perfect use”?

Background

This study was conducted to estimate the readability and related features of English-language over-the-counter (OTC) pre-coital female contraceptive (PFC) instructions.

Study Design

We identified and purchased all currently available OTC PFCs (n=8), including Encare (Contraceptive Gel® and Insert®), F.C. Female Condom®, Ortho Options® (Conceptrol,® Delfen® and Gyncol II Jelly®), Today Sponge® and VCF Vaginal Film®. Reading grade level was calculated using the Simple Measure of Gobbledygook. Text point size was measured and total number of graphics was tallied. Graphic dimensions were also measured. We also assessed OTC PFC instructions on four main criteria — derived from the “User-Friendliness Tool (UFT)” — including layout features, graphic characteristics, presence of a clear message and presentation of manageable information.

Results

Reading level ranged from 8th to 12th grade (mean±SD=10.0±1.2). Mean page length was 24.4±7.0 cm (9.6±2.76 in.), while average page width was 20.3±13.8 cm (7.99±5.43 in.). Average text point size was 7.9±2.3 (range=6-12). Illustrations, predominantly line drawings, were used throughout (range=3-11), and most were similar in size to a matchbox. None of the “How to Use” sections scored high in all criteria on the UFT.

Conclusions

“How to Use” sections of OTC PFC instructions should be revised to be easier to read and more user friendly. Ideally, the gap between “typical” and “perfect” contraceptive efficacy could potentially be narrowed if instructions were developed that the large majority of women could easily understand.     

Hand-Held Indirect Calorimeter Offers Advantages Compared with Prediction Equations, in a Group of Overweight Women, to Determine Resting Energy Expenditures and Estimated Total Energy Expenditures during Research Screening

Objective

To compare standardized prediction equations to a hand-held indirect calorimeter in estimating resting energy and total energy requirements in overweight women.

Design

Resting energy expenditure (REE) was measured by hand-held indirect calorimeter and calculated by prediction equations Harris-Benedict, Mifflin-St Jeor, World Health Organization/Food and Agriculture Organization/United Nations University (WHO), and Dietary Reference Intakes (DRI). Physical activity level, assessed by questionnaire, was used to estimate total energy expenditure (TEE).

Subjects

Subjects (n=39) were female nonsmokers older than 25 years of age with body mass index more than 25.

Statistical analyses

Repeated measures analysis of variance, Bland-Altman plot, and fitted regression line of difference. A difference within ±10% of two methods indicated agreement.

Results

Significant proportional bias was present between hand-held indirect calorimeter and prediction equations for REE and TEE (P<0.01); prediction equations overestimated at lower values and underestimated at higher values. Mean differences (±standard error) for REE and TEE between hand-held indirect calorimeter and Harris-Benedict were −5.98±46.7 kcal/day (P=0.90) and 21.40±75.7 kcal/day (P=0.78); between hand-held indirect calorimeter and Mifflin-St Jeor were 69.93±46.7 kcal/day (P=0.14) and 116.44±75.9 kcal/day (P=0.13); between hand-held indirect calorimeter and WHO were −22.03±48.4 kcal/day (P=0.65) and −15.8±77.9 kcal/day (P=0.84); and between hand-held indirect calorimeter and DRI were 39.65±47.4 kcal/day (P=0.41) and 56.36±85.5 kcal/day (P=0.51). Less than 50% of predictive equation values were within ±10% of hand-held indirect calorimeter values, indicating poor agreement.

Conclusions

A significant discrepancy between predicted and measured energy expenditure was observed. Further evaluation of hand-held indirect calorimeter research screening is needed.     

Fourth Graders' Reports of Fruit and Vegetable Intake at School Lunch: Does Treatment Assignment Affect Accuracy?

Objective

Dietary interventions with children often use self-reported data to assess efficacy despite that objective methods rarely support self-report findings in validation studies. This study compared fourth graders' self-reported to observed lunch fruit and vegetable intake to determine if the accuracy of self-reported intake varied by treatment condition.

Design

Matched randomized follow-up design examined three treatment groups (high and low intensity interventions and control) post-intervention.

Subjects/setting

Three hundred seventy-nine middle-school children participating in a randomized controlled trial of a school-based fruit and vegetable intervention were observed during school lunch one day and asked to recall intake the following day.

Main outcome measures

Food items were coded as: “match,” “omission,” or “intrusion.” Students were classified as accurate if all food items matched, otherwise inaccurate. Matched foods' portions were compared for accuracy. Servings were computed for total fruit and vegetable intake.

Analyses

Accuracy for fruits and vegetables were compared in separate analyses and tested for multiple potential associates: treatment condition, sex, race, body mass index, subsidized meal eligibility, school district, fruit/vegetable availability, age, and test scores. Fitted multivariable regression models included variables found to be significant in univariate or χ² analyses.

Results

Variables found to be significant for fruit item accuracy were availability at lunch, body mass index, and subsidized lunch eligibility. For vegetable item accuracy, availability at lunch was significant. No differences were found for food portions or for efficacy of the intervention between the two methods of dietary data collection: observation and self-report.

Conclusions

Condition assignment did not bias recalled fruit and vegetable intakes among fourth graders.     

Real-world effectiveness of a German school-based intervention for primary prevention of anorexia nervosa in preadolescent girls

Objective

Anorexia nervosa (‘AN’) is notoriously difficult to treat, has high mortality rates, and has a prevalence peak in 15-year-old girls. We developed a German school-based intervention program (‘PriMa’) for the primary prevention of AN in preadolescent girls and assessed the effects in a sample of Thuringian girls.

Method

Intervention involved nine guided lessons with special posters and group discussions. A parallel controlled trial with pre-post measurements and a three-month follow-up was conducted in 92 Thuringian schools (n = 1553 girls) in 2007 and 2008. Primary outcomes were conspicuous eating behavior, body self esteem, and AN-related knowledge.

Results

After adjusting for the girls' ages and the type of school, we observed significant improvements in the areas of knowledge (d = .24) and body self esteem (d = .29), but not for eating behavior.

Conclusion

The PriMa intervention provides an efficient and practical model to increase AN-related protection factors.     

A randomized cross-over study of the metabolic and hormonal responses following two preoperative conditioning drinks

Objective

Preoperative conditioning with carbohydrate-based drinks attenuates postoperative insulin resistance and leads to clinical benefits. The use of metabolic conditioning agents such as glutamine and antioxidants, in addition to carbohydrate, may benefit patients undergoing major surgery, because glutamine and antioxidant supplementation have been shown to improve gastrointestinal perfusion, immune function, morbidity, and gluco-metabolic control in critically ill patients. We investigated the postprandial responses after ingestion of a clear carbohydrate drink (CCD) containing 50 g of carbohydrate (preOp, Nutricia, Trowbridge, UK) and that of another drink containing 50 g of carbohydrate, 15 g of glutamine, and antioxidants (ONS; Fresenius Kabi, Bad Homburg, Germany).

Methods

Twelve overnight-fasted healthy male subjects ingested one of the drinks in a randomized, double-blinded, cross-over manner, after which blood was sampled for 360 min for measurement of glucose, insulin, glucagon, non-esterified fatty acids, β-hydroxybutyrate and glutamine.

Results

The means ± standard errors for age and body mass index of participants were 21 ± 0.9 y and 23.2 ± 0.5 kg/m². After CCD ingestion, glucose and insulin concentrations peaked within 40 min (8.4 ± 0.4 mmol/L and 43.9 ± 3.8 mIU/L, respectively) and returned to baseline at 80 min (glucose 4.9 ± 0.3 mmol/L) and 140 min (insulin 5.5 ± 0.5 mIU/L). After ONS ingestion, peak glucose and insulin concentrations occurred within 40 min but were of a lower magnitude (6.6 ± 0.1 mmol/L and 29.6 ± 2.9 mIU/L, respectively). Glucose concentrations after ONS were higher than after CCD at 100 min.

Conclusion

Peak insulin and glucose concentrations were higher after CCD ingestion; in contrast, responses after ONS ingestion were “blunted” and prolonged.