Journal of The American Dietetic Association最新文献

Background

Fruits and vegetables (F/V) have been examined extensively in nutrition research in relation to colorectal cancer (CRC). However, their protective effect is subject to debate, possibly because of different effects on different subsites of the large bowel.

Objective

To determine whether any association between F/V consumption and risk of CRC differed by subsite of the bowel (proximal colon, distal colon, and rectum).

Design

The Western Australian Bowel Health Study is a population-based, case-control study conducted between June 2005 and August 2007. Complete food frequency questionnaire data were analysed from 834 CRC cases and 939 controls. Logistic regression analysis was used to estimate the effects of quartiles of F/V intake on risk of CRC at different subsites. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for CRC overall and for the three separate subsites.

Results

Risk of proximal colon cancer and rectal cancer was not associated with intakes of total F/V, total vegetable, or total fruit. Brassica vegetable intake was inversely related with proximal colon cancer (Q4 vs Q1 OR 0.62; 95% CI 0.41 to 0.93). For distal colon cancer, significant negative trends were seen for total F/V, and total vegetable intake. Distal colon cancer risk was significantly decreased for intake of dark yellow vegetables (Q4 vs Q1 OR 0.61; 95% CI 0.41 to 0.92) and apples (Q4 vs Q1 OR 0.51; 95% CI 0.34 to 0.77). An increased risk for CRC was found to be associated with intake of fruit juice (Q4 vs Q1 OR 1.74; 95% CI 1.24 to 2.45).

Conclusions

Our results suggest that different F/V may confer different risks for cancer of the proximal colon, distal colon, or rectum. Future studies might consider taking into account the location of the tumor when examining the relation between F/V consumption and risk of CRC.

Fruit and vegetable (F/V) intake in the United States remains below recommended levels despite evidence of the health benefits of regular consumption. Efforts to increase F/V intake include behavior-based interventions. A systematic review of MEDLINE PubMed and PsycINFO databases (2005–2010) was conducted to identify behavior-based intervention trials designed to promote F/V intake. Using predetermined limits and selection criteria, 34 studies were identified for inclusion. Behavior-based interventions resulted in an average increase in F/V intake of +1.13 and +0.39 servings per day in adults and children, respectively. Interventions involving minority adults or low-income participants demonstrated average increases in daily F/V consumption of +0.97 servings/day, whereas worksite interventions averaged +0.8 servings/day. Achieving and sustaining F/V intake at recommended levels of intake across the population cannot be achieved through behavior-based interventions alone. Thus, efforts to combine these interventions with other approaches including social marketing, behavioral economics approaches, and technology-based behavior change models should be tested to ensure goals are met and sustained.

Validated self-report methods of dietary assessment exist and might be improved in terms of both accuracy and cost-efficiency with computer technology. The objectives of this preliminary study were to develop an initial version of an interactive CD-ROM program to estimate fruit, vegetable, and fat intake, and to compare it to multiple 24-hour dietary recalls (averaged over 3 days). In 2009, overweight male and female adults (n=205) from Lane County, OR, completed computerized and paper versions of fruit, vegetable, and fat screening instruments, and multiple 24-hour dietary recalls. Summary scores from the 10-item National Cancer Institute Fruit and Vegetable Scan and the 18-item Block Fat Screener were compared to multiple 24-hour dietary recall−derived fruit/vegetable and fat intake estimates (criterion measures). Measurement models were used to derive deattenuated correlations with multiple 24-hour dietary recalls of paper and CD-ROM administrations of Fruit and Vegetable Scan fruit intake, vegetable intake, and fruit and vegetable intake, and Block Fat Screener fat intake. The computerized assessment and paper surveys were related to multiple 24-hour dietary recall−derived fruit/vegetable and fat intake. Deattenuated correlation coefficients ranged from 0.50 to 0.73 (all P≤0.0001). The CD-ROM−derived estimate of fruit intake was more closely associated with 24-hour dietary recall (r=0.73) than the paper-derived estimate (r=0.54; P<0.05), but the other comparisons did not differ significantly. Findings from this preliminary study with overweight adults indicate the need for additional enhancements to the CD-ROM assessment and more extensive validation studies.

Background

Consumption of certain dietary patterns, such as a Western diet, has been associated with unfavorable physiologic outcomes. Diet has been proposed as a contributor to allostatic load, a composite measure of physiological dysregulation.

Objective

To determine the association of dietary patterns, defined by “meat and french fries,” “traditional Puerto Rican foods” (rice, beans, and oils), or “sweets,” with allostatic load, and with the 10 individual physiologic parameters that comprise it.

Participants

Baseline data collected from participants of the Boston Puerto Rican Health Study (n=1,117; aged 45 to 75 years) was used to run linear and logistic regression models, adjusting for age, sex, alcohol intake, smoking, medications, energy intake, and body mass index or physical activity.

Results

Significant trends across increasing quintiles of the meat and french fries pattern were observed for higher allostatic load score (P=0.002), waist circumference (P=0.032), systolic blood pressure (P=0.008), and diastolic blood pressure (P<0.0001). Participants in the highest quintile of the meat and french fries pattern had significantly higher allostatic load score than those in the lowest quintile (mean 4.3±0.11 vs 3.9±0.12, P=0.030), and had higher odds of having high allostatic load (odds ratio [95% confidence interval]: 1.8 [1.2 to 2.9]), low dehydroepiandrosterone sulfate (odds ratio 1.9 [95% confidence interval: 1.2 to 3.1]), and high glycosylated hemoglobin (odds ratio 1.7 (95% confidence interval: 1.0 to 2.9]). The traditional pattern was not associated with allostatic load, whereas a significant association between the sweets pattern and allostatic load disappeared after restricting analysis to participants without diabetes.

Conclusions

A meat, processed meat, and french fries dietary pattern may contribute to the deregulation of multiple physiologic parameters in Puerto Rican adults. Efforts to limit consumption of this pattern may help prevent further cumulative physiological dysregulation in this high risk population.