1. J Korean Neurosurg Soc. 2009 Nov;46(5):443-50. Epub 2009 Nov 30.
Estimated number of korean adults with back pain and population-based associated
factors of back pain : data from the fourth Korea national health and nutrition
examination survey.
Jhun HJ, Park JY.
Cha Biomedical Center, Kangnam Cha Hospital, CHA University, Seoul, Korea.
OBJECTIVE: We estimated the number of Korean adults with back pain and evaluated
population-based associated factors of back pain from a representative sample
data from the Fourth Korea National Health and Nutrition Examination Survey.
METHODS: The number of Korean adults who experienced back pain (experienced
patients), those who experienced back pain lasting for three or more months
during the past year (chronic patients), and those who were currently suffering
from back pain (current patients) were estimated by analyzing the data from the
fourth Korea National Health and Nutrition Examination Survey conducted in 2007
using surveyfreq procedure of the SAS statistical package. Population-based odds
ratios for being experienced, chronic, and current patient according to
demographic (age and gender), socioeconomic (education and occupation), and
lifestyle factors (smoking, drinking, and exercise) were estimated using
surveylogistic procedure. RESULTS: It was estimated that there were 5,554,256
(proportion, 15.4%; 95% CI, 4,809,466 - 6,299,046) experienced patients,
2,060,829 (5.7%; 1,557,413-2,564,246) chronic patients, and 3,084,188 (8.5%;
2,600,197 - 3,568,179) current patients among 36,107,225 Korean adults aged 20-89
years in 2007. Each of explanatory variables was significantly associated with at
least one of the response variables for back pain. CONCLUSION: Based on our study
results, further efforts to investigate epidemiology of back pain, to evaluate
associated factors, and to improve treatment outcomes are needed.
PMCID: PMC2796350
PMID: 20041054 [PubMed - in process]
2. J Occup Environ Med. 2009 Dec;51(12):1422-36.
Bone lead level prediction models and their application to examine the
relationship of lead exposure and hypertension in the Third National Health and
Nutrition Examination Survey.
Park SK, Mukherjee B, Xia X, Sparrow D, Weisskopf MG, Nie H, Hu H.
Department of Environmental Health Sciences, University of Michigan School of
Public Health, Ann Arbor, MI 48109, USA.
OBJECTIVE: We developed prediction models for bone lead using blood lead levels
and other standard covariates in a community-based cohort of older men. METHODS:
Participants having bone lead levels measured by K X-ray fluorescence were
included in the model selection process (n = 825). Predictors of each tibia and
patella lead were identified in three quarters of the population and then
predicted the bone lead levels in the remaining one quarter and in the Community
Lead Study. RESULTS: Eighteen predictors were selected for tibia (blood lead,
age, education, occupation, smoking status, pack-years of cigarette, serum levels
of phosphorus, uric acid, calcium, creatinine and total and high-density
lipoprotein cholesterols, hematocrit, body mass index, systolic and diastolic
blood pressure, and diagnoses of cancer and diabetes; R2 = 0.32) and 16 for
patella lead (among the predictors included in the tibia model diagnosis of
cancer, serum levels of calcium, and total cholesterol were not included in
patella lead model, but diagnosis of hypertension was included; R2 = 0.34),
respectively. The correlation coefficients between the observed and predicted
values were 0.43 to 0.50 for tibia and 0.52 to 0.58 for patella lead in internal
and external validation. We applied these predicted bone lead models to the Third
National Health and Nutrition Examination Survey (NHANES-III) to examine
associations with hypertension and found relatively more significant associations
compared with blood lead. CONCLUSIONS: This study suggests that the prediction
equations may be used to predict bone lead levels in other community-based
cohorts with reasonable accuracy.
PMID: 19952788 [PubMed - in process]
3. Nutr Health. 2009;20(2):91-105.
Cholesterol levels in later life amongst UK Channel Islanders exposed to the
1940-45 German occupation as children, adolescents and young adults.
Head RF, Gilthorpe MS, Ellison GT.
St George's, University of London. rosie.green@natcen.ac.uk
BACKGROUND: To clarify the nature of the relationship between: food deprivation
and undernutrition during pre- and postnatal development; and cholesterol levels
in later life, this study examined the relationship between birth weight (as a
marker of prenatal nutrition) and cholesterol levels among 396 Guernsey islanders
(born in 1923-1937), 87 of whom (22%) had been exposed to food deprivation as
children, adolescents or young adults (i.e. to postnatal undernutrition) during
the 1940-45 German occupation of the Channel Islands, and 309 of whom (78%) had
left or been evacuated from the islands before the occupation began. METHODS:
Three sets of multiple regression models were used to investigate: Model A - the
relationship between birth weight and cholesterol levels; Model B - the
relationship between postnatal exposure to the occupation and cholesterol levels;
and Model C - any interaction between birth weight, postnatal exposure to the
occupation and cholesterol levels. Model A and Model B also tested for any
interactions between: birth weight/occupation exposure and sex; and birth
weight/occupation exposure and parish of residence at birth (as a marker of
parish of residence during the occupation and related variation in the severity
of food deprivation). RESULTS: Before (and after) adjusting for potential
confounders, no statistically significant relationships were observed between
either birth weight (before adjustment: 0.09 mmol/l per kg increase, 95% CI:
-0.30, 0.16; after adjustment: 0.08 mmol/l per kg increase, 95%CI: -0.17, 0.34)
or exposure to the occupation (before adjustment: 0.01 mmol/l for exposed group,
95%CI: -0.24, 0.27; after adjustment: 0.04 mmol/l for exposed group, 95%CI:
-0.26, 0.33) and cholesterol levels in later life. There was also little evidence
of significant relationships between birth weight, exposure to the occupation and
cholesterol levels in later life when Model A and Model B were stratified by sex
or parish of residence at birth, although there was a significant positive
relationship between birth weight and cholesterol levels in women (0.44 mmol/l
per kg increase, 95%CI: 0.07, 0.81). CONCLUSIONS: These analyses provide little
support for the theory that birth weight is inversely related to cholesterol
levels in later life. and do not offer any evidence in support of a relationship
between undernutrition in childhood, adolescence and early adulthood and
cholesterol levels in later life. However, further research may determine whether
undernutrition at different stages of the life-course may influence cholesterol
levels in later life.
PMID: 19835106 [PubMed - indexed for MEDLINE]
4. BMC Public Health. 2009 Jul 2;9:215.
Association of socioeconomic status with overall overweight and central obesity
in men and women: the French Nutrition and Health Survey 2006.
Vernay M, Malon A, Oleko A, Salanave B, Roudier C, Szego E, Deschamps V, Hercberg
S, Castetbon K.
Nutritional Surveillance and Epidemiology Unit, Institut de Veille Sanitaire,
Université Paris 13, Conservatoire des Arts et Métiers, Bobigny, France.
michel.vernay@univ-paris13.fr
BACKGROUND: Identification of subpopulations at high risk of overweight and
obesity is crucial for prevention and management of obesity in different
socioeconomic status (SES) categories. The objective of the study was to describe
disparities in the prevalence of overweight and obesity across socioeconomic
status (SES) groups in 18-74 year-old French adults. METHODS: Analyses were based
on a multistage stratified random sample of non-institutionalized adults aged
18-74-years-old from the French Nutrition and Health Survey (ENNS), a
cross-sectional national survey carried out in 2006/2007. Collected data included
measured anthropometry (weight, height and waist circumference (WC)), demographic
and SES data (occupation, education and frequency of holiday trips as a marker of
family income). SES factors associated with overweight (BMI > or = 25) and
central obesity (WC above gender-specific references) were identified using
multiple logistic regression. RESULTS: Almost half (49.3%) of French adults were
overweight or obese and 16.9% were obese. In men, the risk of overall overweight
or obesity was associated with occupation (p < 0.05), whereas the risk of central
obesity was independently associated with occupation (p < 0.05) and frequency of
holiday trips (p < 0.01). In women, both overall and central overweight and
obesity were independently associated with educational level (respectively p <
10(-3) and p < 10(-3)) and frequency of holiday trips (respectively p < 0.05 and
p < 10-3). CONCLUSION: The prevalence of overweight and obesity was found to be
similar to that of several neighbouring western European countries, and lower
than the UK and eastern Europe. Risk of being overweight or obese varied across
SES groups both in men and women, but associations were different between men and
women, indicating differing determinants.
PMCID: PMC2714511
PMID: 19573222 [PubMed - indexed for MEDLINE]
5. J Public Health Manag Pract. 2009 May-Jun;15(3):223-31.
Active living for rural youth: addressing physical inactivity in rural
communities.
Yousefian A, Ziller E, Swartz J, Hartley D.
Maine Rural Health Research Center, Institute for Health Policy, Muskie School of
Public Service, University of Southern Maine, Portland, Maine 04104, USA.
Rural youth are at greater risk than urban youth for obesity and physical
inactivity. Active living research incorporates an ecological approach to
promoting physical activity (PA) by recognizing that individual behavior, social
environments, physical environments, and policies contribute to behavior change.
Active living research and interventions have been limited primarily to urban
settings. Because rural communities have unique environmental features and
sociocultural characteristics, this project combines insights from current active
living models with more focused consideration of the physical and social
realities of rural areas. In this study, we report on our efforts to develop,
test, and refine a conceptual model describing the interaction between the
individual and the environment as it enhances or thwarts active living in rural
communities. Our findings revealed a host of relevant "predisposing" and
"enabling" factors, including sociodemographic, environmental, policy, and
programmatic elements, that extend across the four domains of active
living--transportation, recreation, occupation, and household. A one-size
approach to PA promotion will not fit the needs of rural youth. Given the unique
challenges that rural communities face, efforts to combat childhood obesity must
consider rural residents a priority population. More research, interventions, and
evaluations on ways to promote rural PA are needed.
PMID: 19363402 [PubMed - indexed for MEDLINE]
6. Asia Pac J Clin Nutr. 2009;18(1):88-95.
Understanding the differences in obesity among working adults between Taiwan and
China.
Shimokawa S, Chang HH, Pinstrup-Andersen P.
Division of Social Science, Hongkong University of Science and Technology,
Kowloon, Hongkong.
OBJECTIVE: To investigate the difference in the prevalence of obesity and the
associations between the risk of obesity and socioeconomic factors with regard to
working adults in China and Taiwan. DATA: The 2000 China Health and Nutrition
Survey and the 2001 National Health Interview Survey in Taiwan, which contains
information from 20-60-year-old working adults in China (3,067 men and 2,998
women) and Taiwan (6,475 men and 6,341 women). METHOD: Variables were converted
to cross-economy comparable forms, and the estimated prevalence of obesity across
socioeconomic groups was compared between China and Taiwan. Probit models were
used to examine the associations between socioeconomic factors and the
probability of being obese. RESULTS: In China, the prevalence of obesity was
higher in the higher income, more educated, and more sedentary occupation groups,
while it was higher in the lower income and less educated groups in Taiwan. Also,
our results indicate that occupational types rather than income and education
levels are more significantly associated with the probability of being obese in
China, whereas income and education levels rather than occupational types are
more significantly associated with the probability of being obese in Taiwan.
These findings may indicate that, when an economy becomes more developed, the
association between obesity risk and income and education levels becomes more
significant and negative especially among women, while the association between
obesity risk and occupational types decreases especially among men.
PMID: 19329401 [PubMed - indexed for MEDLINE]
7. Community Dent Oral Epidemiol. 2009 Jun;37(3):267-75. Epub 2009 Mar 19.
Racial/ethnic variations in associations between socioeconomic factors and tooth
loss.
Jimenez M, Dietrich T, Shih MC, Li Y, Joshipura KJ.
Harvard School of Public Health, Boston, MA, USA. monik_jimenez@hsdm.harvard.edu
OBJECTIVES: To compare the associations between socioeconomic factors and tooth
loss among White, Black, and Mexican-American people. METHODS: Analyses were
conducted on 16,821 adults, using data from the National Health and Nutrition
Examination Survey-III. Age- and multivariate-adjusted negative binomial
regressions were used to explore the relation of socioeconomic factors, region of
residence, gender, and foreign birth with the number of missing teeth. Effect
modification by race/ethnicity was assessed by the inclusion of interaction
terms. RESULTS: In multivariate-adjusted analyses, non-Hispanic White people with
9-12 years of education exhibited 71% higher mean number of missing teeth than
those with >12 years of education [incidence rate ratio (IRR) = 1.71, 95%
confidence interval (CI): 1.52-1.92]. Education was unrelated to the number of
teeth among non-Hispanic Black people (IRR = 1.16; 95% CI: 1.00-1.35) or
Mexican-Americans (IRR = 1.10, 95% CI: 0.93-1.31). The poorest White people
exhibited 39% more missing teeth, on average, than the most affluent White
people, but no association between poverty and number of teeth was observed among
Black or Mexican-American people. CONCLUSIONS: The associations between
socioeconomic factors and tooth loss vary across race/ethnicity. This suggests
that the health benefits associated with high socioeconomic status are not
equally shared across racial/ethnic groups.
PMCID: PMC2758161 [Available on 2010/6/1]
PMID: 19302573 [PubMed - indexed for MEDLINE]
8. Am J Ind Med. 2009 May;52(5):358-71.
Exposure to hazardous workplace noise and use of hearing protection devices among
US workers--NHANES, 1999-2004.
Tak S, Davis RR, Calvert GM.
Division of Surveillance, Hazard Evaluations, and Field Studies, National
Institute for Occupational Safety and Health, Centers for Disease Control and
Prevention, Cincinnati, Ohio 45226, USA. stak@cdc.gov
BACKGROUND: To estimate the prevalence of workplace noise exposure and use of
hearing protection devices (HPDs) at noisy work, NIOSH analyzed 1999-2004 data
from the National Health and Nutrition Examination Survey (NHANES). METHODS: A
total of 9,275 currently employed workers aged > or =16 years were included in
the weighted analysis. Hazardous workplace noise exposure was defined as
self-reported exposure to noise at their current job that was so loud that the
respondent had to speak in a raised voice to be heard. Industry and occupation
were determined based on the respondent's current place and type of work.
RESULTS: Twenty-two million US workers (17%) reported exposure to hazardous
workplace noise. The weighted prevalence of workplace noise exposure was highest
for mining (76%, SE = 7.0) followed by lumber/wood product manufacturing (55%, SE
= 2.5). High-risk occupations included repair and maintenance, motor vehicle
operators, and construction trades. Overall, 34% of the estimated 22 million US
workers reporting hazardous workplace exposure reported non-use of HPDs. The
proportion of noise-exposed workers who reported non-use of HPDs was highest for
healthcare and social services (73.7%, SE = 8.1), followed by educational
services (55.5%). DISCUSSION: Hearing loss prevention and intervention programs
should be targeted at those industries and occupations identified to have a high
prevalence of workplace noise exposure and those industries with the highest
proportion of noise-exposed workers who reported non-use of HPDs. Published 2009
Wiley-Liss, Inc.
PMID: 19267354 [PubMed - indexed for MEDLINE]
9. Salud Publica Mex. 2009 Jan-Feb;51(1):19-25.
Maternal MTHFR polymorphisms and risk of spontaneous abortion.
Rodríguez-Guillén Mdel R, Torres-Sánchez L, Chen J, Galván-Portillo M,
Blanco-Muñoz J, Anaya MA, Silva-Zolezzi I, Hernández-Valero MA, López-Carrillo L.
National Institute of Public Health, Morelos, México.
OBJECTIVE: To asses the association between intake of folate and B vitamins and
the incidence of spontaneous abortion (SA) according to the maternal
methylenetetrahydrofolate reductase (MTHFR) polymorphisms (677 C>T and 1298 A>C).
MATERIAL AND METHODS: We conducted a nested case-control study within a perinatal
cohort of women recruited in the state of Morelos, Mexico. Twenty-three women
with SA were compared to 74 women whose pregnancy survived beyond week 20th.
Intake of folate and B vitamins respectively, was estimated using a validated
food frequency questionnaire. Maternal MTHFR polymorphisms were determined by
PCR-RFLP and serum homocysteine levels by HPLC. RESULTS: Carriers of MTHFR 677TT
and 1298AC genotypes respectively showed an increased risk of SA (OR 677TT vs.
CC/CT=5.0; 95% CI: 1.2, 20.9 and OR 1298 AC vs. AA=5.5; 95% CI: 1.1, 26.6).
CONCLUSIONS: Our results support the role of MTHFR polymorphisms as a risk factor
for SA, regardless of dietary intake of B vitamins.
PMID: 19180309 [PubMed - indexed for MEDLINE]
10. Soc Sci Med. 2009 Mar;68(5):858-66. Epub 2009 Jan 2.
The contribution of material, psychosocial, and behavioral factors in explaining
educational and occupational mortality inequalities in a nationally
representative sample of South Koreans: relative and absolute perspectives.
Khang YH, Lynch JW, Yang S, Harper S, Yun SC, Jung-Choi K, Kim HR.
Department of Preventive Medicine, University of Ulsan College of Medicine,
Seoul, 138-736 South Korea. youngk@amc.seoul.kr
The contributions of material, psychosocial, and behavioral factors in explaining
socioeconomic inequalities in health have been explored in many Western studies.
Most prior investigations have looked at relative abilities to explain such
inequalities. In addition, little research focuses on Asian countries, despite
the fact that the prevalence and socioeconomic distribution of risk factors for
mortality are different there. This study examined relative and absolute
abilities of material, psychosocial, and behavioral pathways to explain
educational and occupational inequalities in mortality in a nationally
representative sample from South Korea. The 1998 and 2001 National Health and
Nutrition Examination Survey data were pooled and linked to national mortality
data. Of 8366 men and women over 30 years of age, 310 died between 1999 and 2005.
Nine pathway variables were examined: three material factors (income, health
insurance, and car ownership status), three psychosocial factors (depression,
stress, and marital status), and three behavioral factors (smoking, alcohol
consumption, and physical exercise). The relative risk and relative index of
inequality were used as measures of relative inequality, and risk differences and
the slope index of inequality were used as measures of absolute inequality.
Material factors explained a total of 29.0% of the excess in relative risk for
education and 50.0% of the excess in relative risk for occupational class.
Material factors explained 78.6% of the excess in absolute mortality difference
for education and 41.1% for occupational class. Psychosocial factors for both
education and occupational class had a relative and absolute explanatory power of
less than 15%. Behavioral factors showed a relative explanatory power of about
15%, but absolute explanatory power reached 84.0% for education and 105.4% for
occupational class. However, the number of deaths used to calculate the absolute
explanatory power was small. Results of this study suggest that absolute
socioeconomic mortality inequalities could be substantially reduced if behavioral
risk factors were reduced in the whole population.
PMID: 19121885 [PubMed - indexed for MEDLINE]
11. J Occup Environ Med. 2008 Dec;50(12):1401-13.
Examining associations between job characteristics and health: linking data from
the Occupational Information Network (O*NET) to two U.S. national health surveys.
Alterman T, Grosch J, Chen X, Chrislip D, Petersen M, Krieg E Jr, Chung H,
Muntaner C.
Division of Surveillance, Hazard Evaluations and Field Studies, National
Institute for Occupational Safety and Health, Cincinnati, Ohio 45213, USA.
talterman@cdc.gov
OBJECTIVE: To determine whether the Occupational Information Network (O*NET)
database can be used to identify job dimensions to serve as proxy measures for
psychosocial factors and select environmental factors, and to determine whether
these factors could be linked to national health surveys to examine associations
with health risk behaviors and outcomes. METHODS: Job characteristics were
obtained from O*NET 98. Health outcomes were obtained from two national surveys.
Data were linked using Bureau of Census codes. Multiple logistic regression was
used to examine associations between O*NET factors and cardiovascular disease,
depression, and health risk factors. RESULTS: Seven of nine work organization or
psychosocial factors were significantly associated with health risk behaviors in
both the National Health and Nutrition Examination Survey III and National Health
Interview Survey. CONCLUSIONS: This study demonstrates a method for linking
independently obtained health and job characteristic data based on occupational
code.
PMID: 19092496 [PubMed - indexed for MEDLINE]
12. Am J Ind Med. 2009 Mar;52(3):179-84.
The relationship between chronic rhinosinusitis and occupation: the 1998, 2001,
and 2005 Korea National health and nutrition examination survey (KNHANES).
Koh DH, Kim HR, Han SS.
Occupational Safety and Health Research Institute, Korea Safety and Health
Agency, Incheon, South Korea.
OBJECTIVES: We examined the relationship between chronic rhinosinusitis and
occupation. METHODS: We analyzed data from the 1998, 2001, and 2005 Korea
National Health and Nutrition Examination Survey (KNHANES). Men and women aged
20-59 who participated in the three KNHANES were included to analyze the
relationship between chronic rhinosinusitis and occupation. Trained interviewers
visited subjects' homes and administered a standardized questionnaire on
diagnosed diseases. Subjects were asked if they had experienced chronic
rhinosinusitis during the previous year or had had rhinosinusitis for three or
more consecutive months. Occupational classification followed the major groups of
the Korean Standard Classification of Occupations (KSCO). We calculated the
prevalence ratios (PRs) of chronic rhinosinusitis by major groups compared with
clerical workers in the three KNHANES. Poisson regression with robust standard
error was conducted, adjusting for age in 10-year strata. RESULTS: There were
significantly increased PRs of chronic rhinosinusitis in plant and machinery
operators and assemblers, elementary occupations, crafts and related trade
workers, and the unemployed. CONCLUSIONS: These results support the relationship
between chronic rhinosinusitis and occupational exposure at the macro level.
PMID: 19051236 [PubMed - indexed for MEDLINE]
13. J Agromedicine. 2007;12(3):5-10.
Respiratory disease in agricultural workers: mortality and morbidity statistics.
Greskevitch M, Kullman G, Bang KM, Mazurek JM.
Division of Respiratory Disease Studies (DRDS), National Institute for
Occupational Safety and Health (NIOSH), Centers for Disease Control and
Prevention (CDC). mgreskevitch@cdc.gov
To quantify the respiratory disease burden among agricultural workers, we
examined the 1988-1998 National Center for Health Statistics (NCHS) "Multiple
Cause of Death Data" and the 1988-1994 Third National Health and Nutrition
Examination Survey data (NHANES III). Proportionate mortality ratios (PMRs) were
determined for 11 respiratory conditions among 6 agricultural groups: crop farm
workers, livestock farm workers, farm managers, landscape and horticultural
workers, forestry workers, and fishery workers. Prevalence ratios (PRs) were
determined for 12 respiratory conditions among 3 agricultural groups: farm
workers, farm managers, and other agricultural workers. Disease categories groups
were based on the 9th International Classification of Diseases and the
agricultural groups on the NCHS or NHANES III industry and occupation codes,
respectively. Crop farm workers and livestock farm workers had significantly
elevated mortality for several respiratory conditions, with mortality for
hypersensitivity pneumonitis being 10 and 50 times higher than expected.
Landscape and horticultural workers had significantly elevated mortality for
abscess of the lung and mediastinum and chronic airways obstruction. Forestry
workers had significantly elevated mortality for pulmonary tuberculosis, chronic
airways obstruction, and pneumonia. Prevalence of wheeze was elevated for female
farm workers, shortness of breath was elevated for farm workers who had ever
smoked, and hay fever was elevated for black, non-Hispanic farm workers.
Prevalence of asthma was elevated for other agricultural workers who had ever
smoked. Farm workers had a PR of 173 for obstructive respiratory abnormality.
Continued improvement in occupational health surveillance systems for agriculture
is essential to help guide prevention efforts for respiratory disease.
PMID: 19042666 [PubMed - indexed for MEDLINE]
14. J Am Diet Assoc. 2008 Dec;108(12):2021-30.
Socioeconomic differences in fruit and vegetable consumption among middle-aged
French adults: adherence to the 5 A Day recommendation.
Estaquio C, Druesne-Pecollo N, Latino-Martel P, Dauchet L, Hercberg S, Bertrais
S.
Department of Nutritional Epidemiology, French Institute of Health and Medical
Research, Bobigny, France. c.estaquio@uren.smbh.univ-paris13.fr
BACKGROUND: Numerous studies support the protective effect of high fruit and
vegetable consumption on chronic disease risk, mainly against cancer and
cardiovascular diseases. The increase of fruit and vegetable intake has become a
public health priority in many countries. OBJECTIVE: The aim of the study was to
investigate the relationships of socioeconomic, demographic, and behavioral
factors with both quantity and variety of fruit and vegetable consumption.
DESIGN/SUBJECTS: Fruit and vegetable intake was assessed using repeated 24-hour
dietary records collected during a 2-year period from 4,282 French subjects
(2,373 men and 1,909 women), aged 45 to 62 years, who participated in a large
prospective study. STATISTICAL ANALYSIS: Both education level and occupation
categories were used as socioeconomic indicators. Logistic regression models were
applied to assess factors related to meeting the 5 A Day fruit and vegetable
recommendation. Covariance analyses were performed to compare the fruit and
vegetable variety scores and the contributions of fruit and vegetables to the
total daily diet cost across socioeconomic indicators within each sex. RESULTS:
Meeting the 5 A Day recommendation was more likely in subjects aged 50 years and
older, higher education levels, nonsmokers, moderate alcohol drinkers and in
women engaging in regular physical activity. The odds ratio (95% confidence
interval) for the lower vs higher education level was 0.70 (0.54 to 0.92) in men
and 0.65 (0.48 to 0.85) in women. No significant difference was observed between
occupation categories. A positive relationship between vegetable variety and
education level was found in both sexes. Fruit variety was positively associated
with both education and occupation categories, but only in men. The contribution
of fruits to the total daily diet cost increased with occupation (P<0.02) and
education (P<0.0001) in men, but decreased with occupation in women (P<0.05).
CONCLUSIONS: Although cost constraints may explain the lower fruit and vegetable
intake in lower socioeconomic groups, the relative influence of budgetary
resources, nutrition knowledge, and social and environmental barriers in
socioeconomic disparities need further investigation.
PMID: 19027405 [PubMed - indexed for MEDLINE]
15. Environ Res. 2009 Jan;109(1):108-15. Epub 2008 Oct 18.
Fish and shellfish consumption estimates and perceptions of risk in a cohort of
occupational and recreational fishers of the Chesapeake Bay.
Harris SA, Urton A, Turf E, Monti MM.
Population Studies and Surveillance, Cancer Care Ontario, 620 University Avenue,
Toronto, ON, Canada M5G 2L7. Shelley.Harris@Cancercare.on.ca
Exposure to persistent, bioaccumulating substances, through the consumption of
contaminated fish is of concern in human populations. Consumption may be
particularly high for subsistence, commercial, and recreational fishers, so it is
important to obtain accurate consumption estimates to assess risks in these
groups. The objectives of the work reported here were: to obtain estimates of
fish and shellfish consumption (meals and portion size) in an occupational
cohort; to determine what percentage of the consumption was from local fish; to
evaluate reliability of two methods of reporting fish and shellfish consumption;
and to examine risk perceptions in relation to consumption. Subjects included 99
recreational and occupational fishers in the Chesapeake Bay area, Virginia, who
were recruited for a cohort study of estuary-associated syndrome. Subjects
reported average fish and shellfish consumption (all species) on a weekly,
monthly or yearly basis, and were asked species-specific information, which was
summed. The median number of fish meals consumed a year was significantly
different depending on the method used, 52 (interquartile range, IQR:24-104)
(average method) and 65 (IQR:30-117) (sum of species-specific), respectively.
Shellfish estimates were 24 (IQR:12-52) (average) and 47 (IQR:31-84) (sum) meals
a year. Of those who consumed fish, participants reported an average meal size of
8.9+/-3.38 oz. (median 8 oz, range 4-16) with close to 70% of fish consumed
self-caught and 50% from Virginia waters. Using multiple regression, occupation,
and risk perceptions were found to be significantly correlated with fish
consumption levels, and consumption of fish from locations under advisory.
PMID: 18930456 [PubMed - indexed for MEDLINE]
16. Niger J Med. 2008 Jul-Aug;17(3):304-9.
Food insecurity, malnutrition and crude oil spillage in a rural community in
Bayelsa State, south-south Nigeria.
Ordinioha B, Sawyer W.
Community Medicine Department, University of Port Harcourt Teaching Hospital,
Port Harcourt. ruralhealthforum@yahoo.com
BACKGROUND: Oil is the main stay of Nigeria's economy, but most residents in the
oil producing communities still depend entirely on the environment for their
sustenance; and so likely to have a problem of food security in the event of a
deleterious impact on the environment. This study is to examine the effect of a
major crude oil spillage on household food security and the nutritional status of
under-five children in the affected communities. This oil spillage occurred in
May 2000, in Etiama Nembe, a rural communityin Bayelsa State, south-south
Nigeria. METHOD: The study was carried out six months after the spill, using
cross-sectional, external control group study design, with a semi-structured
questionnaire and anthropometry as the study tools. The study participants were
chosen using a two-stage cluster sampling technique. The questionnaire assessing
food insecurity was administered on an adult woman in each of the chosen
households, while the anthropometric measurements were taken for every under-five
year child in the household. RESULTS: A total of 592 questionnaires were
administered and retrieved in both study communities, while anthropometric
measurements of 956 under-five year children were taken. There were no
significant differences in the age and occupations of the respondents, and in the
sizes of their households; although, the respondents in the exposed communities
were significantly better educated (p-value < 0.001). There were significant
differences in the study groups, in household food security (p-value < 0.000001),
and in the prevalence of under-five children with underweight (p-value <0.0001),
and wasting (p-value <0.01). CONCLUSIONS: Crude oil spillage can increase
household food insecurity and childhood malnutrition in the affected communities.
Efforts should always be made to provide food aid to affected communities,
irrespective of the cause of the spillage.
PMID: 18788258 [PubMed - indexed for MEDLINE]
17. Environ Health Perspect. 2008 Aug;116(8):1015-22.
Diet and nondiet predictors of urinary 3-phenoxybenzoic acid in NHANES 1999-2002.
Riederer AM, Bartell SM, Barr DB, Ryan PB.
Department of Environmental and Occupational Health, Rollins School of Public
Health, Emory University, Atlanta, Georgia 30322, USA. arieder@sph.emory.edu
Erratum in:
Environ Health Perspect. 2008 Aug;116(8):1021.
BACKGROUND: 3-Phenoxybenzoic acid (3PBA), a pyrethroid metabolite, was detected
in 75% of urine samples analyzed for pesticides in the U.S. National Health and
Nutrition Examination Survey (NHANES) 1999-2002. NHANES also includes 24-hr diet
data and information on household pesticide use, activities, occupation,
demographics, and other exposure factors. OBJECTIVES: The objective of our study
was to explore the relative importance of diet versus nondiet predictors in
explaining variability in urinary 3PBA. A secondary objective was to explore
whether the NHANES data could be used to identify particular foods driving 3PBA
levels. METHODS: We divided subjects into child (6-10 years of age), teen (11-18
years), and adult (> or = 19 years) age groups and restricted our analyses to
subjects in the morning sampling session who fasted for > or = 8 hr beforehand.
Regression modeling consisted of several model-building steps and a final Tobit
regression on the left-censored log 3PBA measurements. We also conducted
bootstrap analyses to evaluate the stability of the regression parameters.
RESULTS: Reported household pesticide use was not significantly associated with
urinary 3PBA in any age group. Diet was significant for all three groups, and
certain foods appeared to contribute more than others. Among adults, tobacco use
was positively associated with 3PBA (p = 0.0326), and positive associations were
suggested with the number of cytochrome p450-inhibiting medications taken (p =
0.0652) and minutes spent gardening (p = 0.0613) in the past month. CONCLUSIONS:
Although exploratory, our findings underline the importance of collecting
accurate data on household pesticide use and dietary intake when evaluating
pyrethroid exposure-biomarker relationships.
PMCID: PMC2516573
PMID: 18709153 [PubMed - indexed for MEDLINE]
18. Am J Ind Med. 2008 Oct;51(10):748-57.
Gender, precarious work, and chronic diseases in South Korea.
Kim IH, Khang YH, Muntaner C, Chun H, Cho SI.
School of Public Health and Institute of Health and Environment, Seoul National
University, Seoul, Korea.
OBJECTIVE: In view of the growing number of nonstandard workers in South Korea,
this study examined whether nonstandard workers reported poorer health compared
to standard workers and assessed whether there were gender differences in the
association between employment status and chronic health outcomes. METHOD: Data
were taken from a representative-weighted sample of 1,563 men and 1,045 women
aged 20-64, from the 2001 National Health and Nutrition Examination Survey.
Nonstandard employment included part-time work, temporary work, and day labor.
Self-rated health and self-reported chronic disease conditions were used as
health measures. MAIN RESULTS: Nonstandard employment was significantly
associated with higher risk of self-rated health and chronic conditions after
adjusting for socioeconomic position (education, occupational class, and income)
and health behaviors (cigarette smoking, alcohol consumption, regular exercise,
and health examinations). However, the pattern in the relation between
nonstandard work and specific health problems greatly differed by gender. Among
men, nonstandard work arrangements were significantly associated with
musculoskeletal disorders (OR 1.97, 95% CI 1.24-3.19) and liver disease (OR 2.83,
95% CI 1.27-6.32). Among women, nonstandard employment was related to mental
disorders (OR 3.25, 95% CI 1.40-7.56). CONCLUSION: The findings clearly indicate
the need for further study of the observed associations, particularly prospective
and analytical studies. Published 2008 Wiley-Liss, Inc.
PMID: 18704916 [PubMed - indexed for MEDLINE]
19. J Prev Med Public Health. 2008 Jul;41(4):232-40.
Nutritional status and the characteristics related to malnutrition in children
under five years of age in Nghean, Vietnam.
Hien NN, Kam S.
Department of Preventive Medicine, School of Medicine, Kyungpook National
University, Daegu, Korea.
OBJECTIVES: This study was conducted to assess the nutritional status and
characteristics related to malnutrition in children less than five years of age
in Nghean, Vietnam. METHODS: In this study, which was conducted in November 2007,
650 child-mother pairs were selected using a two-stage cluster sampling
methodology. A structured questionnaire was then administered to the mothers in
their home settings. Anthropometric measurement was then used to determine if
children were underweight (weight-for-age), wasting (weight-for-height) and
stunting (height-for-age) based on reference data from the National Center for
Health Statistics (NCHS)/World Health Organization (WHO). Logistic regression
analysis was then used to describe the hierarchical relationships between
potential risk factors and malnutrition. RESULTS: The mean Z-scores for
weight-for-age, height-for-age and weight-for-height were -1.46 (95% CI=-1.57,
-1.35), -1.44 (95% CI=-1.56, -1.32) and -0.71 (95% CI=-0.82, -0.60),
respectively. Of the children included in this study, 193 (31.8%) were
underweight, 269 (44.3%) were stunting and 72 (11.9%) were wasting. Region of
residence, the mother's level of education and occupation, household size, number
of children in the family, weight at birth and duration of exclusive
breastfeeding were found to be significantly related to malnutrition.
CONCLUSIONS: The findings of this study indicate that malnutrition is still an
important problem among children less than five years of age in Nghean, Vietnam.
In addition, maternal, socio-economic and environment factors were found to be
significant factors for malnutrition among children under five.
PMID: 18664729 [PubMed - indexed for MEDLINE]
20. Menopause. 2008 Nov-Dec;15(6):1103-8.
Earlier age at menopause, work, and tobacco smoke exposure.
Fleming LE, Levis S, LeBlanc WG, Dietz NA, Arheart KL, Wilkinson JD, Clark J,
Serdar B, Davila EP, Lee DJ.
Department of Epidemiology and Public Health, University of Miami Miller School
of Medicine, Miami, FL 33136, USA. lfleming@med.miami.edu
OBJECTIVE: Earlier age at menopause onset has been associated with increased
all-cause, cardiovascular, and cancer mortality risks. The risk of earlier age at
menopause associated with primary and secondary tobacco smoke exposure was
assessed. DESIGN: This was a cross-sectional study using a nationally
representative sample of US women. A total of 7,596 women (representing an
estimated 79 million US women) from the National Health and Nutrition Examination
Survey III were asked time since last menstrual period, occupation, and tobacco
use (including home and workplace second-hand smoke [SHS] exposure). Blood
cotinine and follicle-stimulating hormone levels were assessed. Logistic
regressions for the odds of earlier age at menopause, stratified on
race/ethnicity in women 25 to 50 years of age and adjusted for survey design,
were controlled for age, body mass index, education, tobacco smoke exposure, and
occupation. RESULTS: Among 5,029 US women older than 25 years with complete data,
earlier age at menopause was found among all smokers and among service and
manufacturing industry sector workers. Among women age 25 to 50 years, there was
an increased risk of earlier age at menopause with both primary smoking and SHS
exposure, particularly among black women. CONCLUSIONS: Primary tobacco use and
SHS exposure were associated with increased odds of earlier age at menopause in a
representative sample of US women. Earlier age at menopause was found for some
women worker groups with greater potential occupational SHS exposure. Thus,
control of SHS exposure in the workplace may decrease the risk of mortality and
morbidity associated with earlier age at menopause in US women workers.
PMCID: PMC2703810
PMID: 18626414 [PubMed - indexed for MEDLINE]
21. Br Dent J. 2008 Jun 14;204(11):E19; discussion 622-3. Epub 2008 Jun 6.
A survey of stress levels, self-perceived health and health-related behaviours of
UK dental practitioners in 2005.
Kay EJ, Lowe JC.
Peninsula Dental School, Research Way, Tamar Science Park, Plymouth, PL6 8BU.
Comment in:
Br Dent J. 2008 Nov 22;205(10):524-5.
OBJECTIVE: To record stress levels and self-perceived health and health-related
behaviours of dentists. DESIGN AND METHOD: A questionnaire was sent to a random
sample of 1,000 BDA members in April 2005. Respondents were questioned about
self-perceived general health, medicine and drug use, tobacco and alcohol use,
self-perceived general well-being, sexual health, occupational health, physical
activity and nutrition. There were also some questions about women's health.
Results were compared to a BDA study of dental professionals' health and
well-being carried out in 1996. RESULTS: A response rate of 55% was achieved (545
replies). Two-thirds (67%) of respondents considered themselves in very good or
excellent health and 53% were happy and interested in life. Only 42% were free
from pain and discomfort and 26% experienced levels of pain that prevented them
from taking part in a few or some activities. The majority (86%) had very or
fairly stressful lives but most (83%) were either very or somewhat satisfied with
their lives. Nearly all respondents (90%) planned to take action to improve their
health during the 12 months following the survey: popular actions planned
included increasing exercise (58%) and losing weight (42%). Very few respondents
used tobacco (4% daily and 4% occasionally) and most (59%) said that only a few
of their friends smoked: 36% had no tobacco-using friends. Only 3% of respondents
had never had alcohol. The Short Michigan alcohol screening test revealed that 6%
of dentists had a drink problem and 9% had alcoholic tendencies. The most common
factors contributing to stress at work were patient demands (75%), practice
management/staff issues (56%), fear of complaints/litigation (54%) and
non-clinical paperwork (54%). More than half (53%) of respondents were relatively
inactive during the day but 57% took some form of physical exercise at least 3-4
times per week. Nearly half (49%) of respondents felt that their level of
physical activity was very likely or somewhat likely to cause them health
problems. CONCLUSION: In spite of the dramatic recent changes to dentistry, the
differences between the results of this study and the results of the research
carried out in 1996 are minimal. Claims that dentistry is a dangerously stressful
occupation are not justified and dentists seem to be as well and happy as other
professional groups. There is however, a slight increase in the use of alcohol.
Stress management and personal and professional awareness training should be
included in the undergraduate curriculum, so that threats to physical and mental
well-being which might occur during a dentist's professional life may be avoided
or addressed.
PMID: 18535535 [PubMed - indexed for MEDLINE]
22. J Prev Med Public Health. 2008 May;41(3):165-72.
[Health inequality measurement in Korea using EuroQol-5 Dimension valuation
weights]
[Article in Korean]
Shin H, Kim D.
Korea Institute for Health and Social Affairs, Seoul, Korea. shinhosung@gmail.com
OBJECTIVES: Despite various government initiatives, including the expansion of
national health insurance coverage, health inequality has been a key health
policy issue in South Korea during the past decade. This study describes and
compares the extent of the total health inequality and the income-related health
inequality over time among Korean adults. METHODS: This study employs the 1998,
2001 and 2005 Korean National Health and Nutrition Examination Surveys
(KNHANESs). The self-assessed health (SAH) ordinal responses, measured on a
five-point scale, rescaled to cardinal values to measure the health inequalities
with using interval regression. The boundaries of each threshold for the interval
regression analysis were obtained from the empirical distribution of the
EuroQol-5 Dimension (EQ-5D) valuation weights estimated from the 2005 KNHANES.
The final model predicting the individuals' health status included age, gender,
educational attainment, occupation, income, and the regional prosperity index.
The concentration index was used to measure and analyze the health inequality.
RESULTS: The KNHANES data showed an unequal distribution of the total health
inequality in favor of the higher income groups, and this is getting worse over
time (0.0327 in 1998, 0.0393 in 2001 and 0.0924 in 2005). The income-related
health inequality in 2005 was 0.0278, indicating that 30.1% of the total health
inequality can be attributed to income. CONCLUSIONS: The findings indicate there
are health inequalities across the sociodemographic and income groups despite the
recent government's efforts. Further research is warranted to investigate what
potential policy actions are necessary to decrease the health inequality in
Korea.
PMID: 18515993 [PubMed - indexed for MEDLINE]
23. Eur J Epidemiol. 2008;23(7):449-58. Epub 2008 May 29.
Occupational social class, risk factors and cardiovascular disease incidence in
men and women: a prospective study in the European Prospective Investigation of
Cancer and Nutrition in Norfolk (EPIC-Norfolk) cohort.
McFadden E, Luben R, Wareham N, Bingham S, Khaw KT.
Institute of Public Health, University of Cambridge, Cambridge, UK.
ecm33@cam.ac.uk
OBJECTIVES: To investigate the association between occupational social class and
cardiovascular disease (CVD) incidence, and the extent to which classical and
lifestyle risk factors explain such relationships, and if any differences persist
after 65 years of age. DESIGN, SETTING AND PARTICIPANTS: Prospective population
study of 22,478 men and women aged 39-79 years living in the general community in
Norfolk, United Kingdom, recruited using general practice age-sex registers in
1993-1997 and followed up for total mortality to 2006. MAIN RESULTS: In both men
and women an inverse relationship was observed between social class and CVD
incidence, with a relative risk of social class V compared to I of 1.90 in men
(95% CI 1.47 to 2.47, P < 0.001) and 1.90 in women (95% CI 1.45 to 2.49, P <
0.001). Adjusting for classical and lifestyle risk factors (age, smoking, BMI,
systolic blood pressure, total blood cholesterol, history of diabetes, physical
activity, weekly alcohol intake and plasma vitamin C levels) had little effect in
men; the relative risk of social class V compared to I of 1.70 (95% CI 1.31 to
2.22, P < 0.001), while there was some attenuation seen in women, relative risk
of social class V compared to I of 1.56 (95% CI 1.18 to 2.05, P = 0.011). The
association persisted in men and women aged > or =65 years. CONCLUSIONS: Some but
not all of the socioeconomic differential in CVD incidence can be explained by
potentially modifiable classical and lifestyle risk factors. Low social class
remains a risk factor for CVD after age 65 years. Further understanding of the
mechanisms underlying the association is needed if we are to reduce inequalities
in health.
PMID: 18509727 [PubMed - indexed for MEDLINE]
24. Am J Ind Med. 2008 Aug;51(8):626-32.
Inflammatory markers and secondhand tobacco smoke exposure among U.S. workers.
Clark JD 3rd, Wilkinson JD, LeBlanc WG, Dietz NA, Arheart KL, Fleming LE, Lee DJ.
Department of Epidemiology and Public Health, University of Miami Miller School
of Medicine, Miami, Florida 33101, USA.
BACKGROUND: Self-reported exposure to secondhand smoke (SHS) has been associated
with elevated inflammatory markers in adults. The association between SHS
indicated by serum cotinine and markers of inflammation has not been investigated
in adult workers. METHODS: Using the subpopulation of employed participants (20
years and older) who were non-smokers and denied home SHS exposure from the
National Health and Nutrition Examination Survey (NHANES) 1999-2002, the
association between serum cotinine and inflammatory markers (C-reactive protein,
fibrinogen, homocysteine, and white blood cells) was analyzed. Inflammatory
marker values were log-transformed and expressed as geometric means with 95%
confidence intervals (CI). Serum cotinine was categorized as either no cotinine
(below the detection limit), low cotinine (above the detection limit and <0.2
ng/ml), or high cotinine (>or=0.2 and <15.0 ng/ml). The association between serum
cotinine and inflammatory markers was analyzed using univariate and
multivariate-adjusted linear regression. RESULTS: Geometric mean serum cotinine
was significantly higher among non-smokers reporting SHS exposure in the
workplace (0.17 vs. 0.10 ng/ml, P < 0.01). Workers exposed to low and high levels
of cotinine had significantly higher homocysteine levels relative to non-exposed
workers; mean homocysteine differences remained significant in the multivariable
model (i.e., 0.363 and 0.491 mg/dl increase, respectively). CONCLUSION: Exposure
to SHS as measured by serum cotinine may result in increased homocysteine levels
among adult workers. These results provide further evidence in support of
universal workplace smoking restrictions in order to protect worker health.
Further research is required to determine the adverse effects of workplace SHS
exposure on cardiovascular risk.
PMID: 18481260 [PubMed - indexed for MEDLINE]
25. J Phys Act Health. 2008 Mar;5(2):229-41.
Interrelations of socioeconomic position and occupational and leisure-time
physical activity in the National Health and Nutrition Examination Survey.
Wolin KY, Bennett GG.
Dept of Preventive Medicine, Feinberg School of Medicine, Northwestern
University, Chicago, IL 60611, USA.
BACKGROUND: The interrelations between various physical activity domains have
received little empirical attention in the United States. Of particular interest,
given the potential applicability to traditionally underserved communities, is
the nature of the association between occupational physical activity (OPA) and
leisure-time physical activity (LTPA). METHODS: 5448 adult men and women who
participated in NHANES 1999-2000 were included in analyses. Linear regression was
used to examine the bivariate and multivariable associations of OPA and education
with LTPA. Generalized logit models were used to examine the association of
education with OPA. RESULTS: We found no association between education and LTPA.
OPA was significantly positively associated with LTPA (P < .001). The association
between OPA and LTPA was not strongest among those with low education and held
only for men in gender-stratified analysis. Education was inversely associated
with OPA (P < .001) in multivariable analysis. CONCLUSIONS: Our findings lend
preliminary support to the hypothesis that OPA is an important determinant of
LTPA, particularly in men. This provides additional support to calls for
assessment of OPA, particularly among individuals of low social class.
PMCID: PMC2742365
PMID: 18382032 [PubMed - indexed for MEDLINE]
26. Soc Sci Med. 2008 May;66(9):1967-78. Epub 2008 Mar 11.
The effect of income and occupation on body mass index among women in the Cebu
Longitudinal Health and Nutrition Surveys (1983-2002).
Colchero MA, Caballero B, Bishai D.
Department of Health Economics and Evaluation, National Institute of Public
Health, Cuernavaca, Mexico. acolchero@correro.insp.mx
We assessed the effects of changes in income and occupational activities on
changes in body weight among 2952 non-pregnant women enrolled in the Cebu
Longitudinal Health and Nutrition Surveys between 1983 and 2002. On average, body
mass index (BMI) among women occupied in low activities was 0.29 kg/m(2)
(standard error 0.11) larger compared to women occupied in heavy activities. BMI
among women involved in medium activities was on average 0.12 kg/m(2) (standard
error 0.05) larger compared to women occupied in heavy activities. A one-unit
increase in log household income in the previous survey was associated with a
small and positive change in BMI of 0.006 kg/m(2) (standard error 0.02) but the
effect was not significant. The trend of increasing body mass was higher in the
late 1980s than during the 1990s. These period effects were stronger for the
women who were younger at baseline and for women with low or medium activity
levels. Our analysis suggests a trend in the environment over the last 20 years
that has increased the susceptibility of Filipino women to larger body mass.
PMID: 18336975 [PubMed - indexed for MEDLINE]
27. World Health Popul. 2007 Apr;9(2):64-82.
Geographic targeting of risk zones for childhood stunting and related health
outcomes in Burkina Faso.
Margai FM.
Department of Geography, Binghamton University, Binghamton, NY, USA.
margai@binghamton.edu
Several studies seeking alternative intervention strategies for chronic food
insecurity in food-poor nations now advocate the simultaneous evaluation of
multiple causative agents to identify and monitor at-risk populations. This study
attempted to do so using a three-tiered conceptual framework that expressed
childhood nutritional health outcomes as a function of basic, underlying and
immediate causes that are manifested at the regional%community level, the
household level and the personal level. Focusing on stunting (short stature) as a
direct cumulative indicator of food insecurity, the geographic patterns of this
nutritional health outcome were mapped using empirical data from Burkina Faso.
The spatial analysis revealed several isolated pockets of at-risk populations.
Further analysis using logistic regression methods revealed significant
disparities in childhood vulnerability based on factors such as urbanization,
geographic accessibility, poverty, maternal education and occupation,
environmental health, and age, gender and dietary intake of the child. Contrary
to research expectations, there were no observed relationships between childhood
nutritional health outcomes and the biophysical characteristics of the
communities. The odds ratios of stunting in the marginal areas with harsh
environmental conditions were comparable to those observed in the wetter,
crop-intensive regions. Overall, the findings underscore the need for broadening
the scope of research beyond physical environmental conditions to include more
socio-economic and anthropogenic factors that result in long-term effects of food
insecurity, particularly among young children.
PMID: 18270507 [PubMed - indexed for MEDLINE]
28. J Occup Environ Med. 2008 Jan;50(1):57-63.
Declining trends in serum cotinine levels in US worker groups: the power of
policy.
Arheart KL, Lee DJ, Dietz NA, Wilkinson JD, Clark JD 3rd, LeBlanc WG, Serdar B,
Fleming LE.
Department of Epidemiology and Public Health, University of Miami Miller School
of Medicine, Miami, FL 33101, USA.
OBJECTIVE: To explore trends in cotinine levels in US worker groups. METHODS:
Using NHANES III data, serum cotinine levels of US workers not smokers nor
exposed to secondhand smoke (SHS) at home were evaluated for trends by
occupational/industrial and race/ethnicity-gender sub-groups. RESULTS: Decreases
from 1988 to 2002 ranged from 0.08 to 0.30 ng/mL (67% to 85% relative decrease),
with largest absolute reductions in: blue-collar and service occupations;
construction/manufacturing industrial sectors; non-Hispanic Black male workers.
CONCLUSIONS: All worker groups had declining serum cotinine levels. Most dramatic
reductions occurred in sub-groups with the highest before cotinine levels, thus
disparities in SHS workforce exposure are diminishing with increased adoption of
clean indoor laws. However, Black male workers, construction/manufacturing sector
workers, and blue-collar and service workers have the highest cotinine levels.
Further reductions in SHS exposure will require widespread adoption of workplace
clean air laws without exemptions.
PMID: 18188082 [PubMed - indexed for MEDLINE]
29. J Biosoc Sci. 2008 Sep;40(5):697-723. Epub 2007 Dec 19.
Traditional occupations and nutritional adaptation among Central Indian caste
populations.
Gautam RK.
Department of Anthropology, Dr. H. S. Gour University Sagar, Madhya Pradesh,
India.
The socioeconomic milieu has benefits and drawbacks for determining level of
nutrition. The Indian population provides an excellent example of
nutrition-driven adaptation. The present paper deals with the relationship
between BMI (body mass index) and traditional occupation and process of
adaptation among adult males of Central India. Anthropometric data collected by
the Anthropological Survey of India on stature, sitting height and weight of 6663
adult males belonging to 22 castes were used for computation of BMI and Cormic
index. The caste groups earning their living as labourers are found to be
shortest (157.4+/-6.5 cm), and the caste group practising priesthood are tallest
(168.6+/-6.6 cm). The prevalence of chronic energy deficiency is found to be
highest (72%) among castes earning their living as daily wage labourers. The
ANOVA on Cormic index and BMI suggests that people within the same occupational
group are more homogeneous than those from different occupational groups. The t
test also supports the homogeneity of the same occupational group.
PMID: 18088450 [PubMed - indexed for MEDLINE]
30. Hum Biol. 2007 Aug;79(4):395-412.
Prevalence and causes of chronic energy deficiency and obesity in Indian women.
Bharati S, Pal M, Bhattacharya BN, Bharati P.
Sociological Research Unit, Indian Statistical Institute, 203 Barrackpore Trunk
Road, Kolkata 700108, India.
We investigate the nutritional status of women in India and its relation to the
prevalence of chronic energy deficiency (CED) and obesity. To do this, we have
used the data from the Indian National Family Health Survey, 1998-1999, on body
mass index (BMI) of ever-married women, ages 15-49 years, along with several
socioeconomic factors, such as level of education, religion or caste,
occupational status, and standard of living index. The study was based on 81,712
women from 26 states and 6 zones, which were grouped according to geographic
proximity of the states of India. A multiple linear regression analysis was done
to see the relation between nutritional status of women and different
socioeconomic factors. The data reveal that the prevalences of CED, overweight,
and obesity in India are 31.2%, 9.4%, and 2.6%, respectively. The incidences of
CED and obesity are negatively related. The prevalence of CED is the lowest in
Arunachal Pradesh and highest in Orissa. Punjab has the highest prevalence of
obesity, and Bihar has the lowest. For the zonewise distribution the Northeast
zone has the lowest degree of prevalence of CED and the East zone is at the
bottom of the list with the highest degree of malnutrition. We also found that
the nutritional status of women goes together with the enhancement of their
educational status, standard of living, and so on. There are also significant
differences between rural and urban sectors and among castes, religions, and
occupations. Furthermore, regression analysis shows that all the socioeconomic
variables considered here significantly affect BMI in Indian women.
PMID: 18075004 [PubMed - indexed for MEDLINE]
31. J Expo Sci Environ Epidemiol. 2008 May;18(3):252-61. Epub 2007 Dec 5.
Serum dioxin levels in residents of Calcasieu and Lafayette parishes, Louisiana
with comparison to the US population.
Wong le EY, Millette MD, Uddin MS, Needham LL, Patterson DG, Turner W, Henderson
A.
Division of Laboratory Sciences, National Center for Environmental Health,
Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
lyw8@cdc.gov
The Agency for Toxic Substances and Disease Registry (ATSDR) used a
cross-sectional study to compare the serum dioxin toxic equivalent (TEQ) levels
of a population-based representative sample of Calcasieu Parish residents aged 15
years and older to a similar group of residents of Lafayette Parish with less
industrial facilities. Serum dioxins consisted of polychlorinated
dibenzo-p-dioxins, polychlorinated dibenzofurans, and dioxin-like polychlorinated
biphenyls. Overall, the mean and distribution of serum dioxin TEQ level in
residents of both parishes were similar by age groups (15-29 years, 30-44 years,
45-59 years, and 60 year and older). When the Calcasieu Parish area was further
divided based on distance to three industrial areas, the mean dioxin TEQ levels
were similar. Serum dioxin TEQ levels in residents of both parishes increased
with age. Calcasieu Parish residents who reported having eaten locally caught
fish, smoked cigarettes, worked in an occupation with potential exposure, or used
pesticides had dioxin levels similar to Lafayette Parish residents who reported
these activities. African Americans had higher dioxin levels than Caucasians in
Lafayette Parish and both races in Calcasieu Parish. The congener profiles were
similar in residents of both parishes. When the combined Calcasieu and Lafayette
Parish data were compared by age group to the National Health and Nutrition
Examination Survey (NHANES) 2001-2002 data, the geometric means for the dioxin
levels in the combined Parish data set were significantly lower than the NHANES
data in all age groups (all P-values <0.0001), except the oldest age group where
the significance level is marginal (P=0.067). The various percentiles of the
youngest age group of the combined parish data were also significantly lower than
those in NHANES. Since the combined parish dioxin levels were below a
representative sampling of the US population, there is no increase in serum
dioxin concentrations in both the parishes.
PMID: 18059427 [PubMed - indexed for MEDLINE]
32. Public Health Nutr. 2008 Aug;11(8):841-8. Epub 2007 Dec 6.
Dietary intake and different types of physical activity: full-day energy
expenditure, occupational and leisure-time.
Camões M, Lopes C.
Department of Hygiene and Epidemiology, University of Porto Medical School,
Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal. mcamoes@med.up.pt
OBJECTIVE: To describe the relationship between dietary intake and different
levels and types of physical activity (PA). DESIGN: Cross-sectional evaluation of
the EPIPorto study. Energy expenditure (metabolic energy equivalent tasks) and
dietary intake during the past year were assessed using a PA questionnaire and a
semi-quantitative food-frequency questionnaire, respectively. SETTING:
Representative sample of adults in Porto, Portugal. SUBJECTS: Data were analysed
for 2404 Portuguese Caucasian adults, aged between 18 and 92 years. RESULTS: For
total PA, males who were active had significantly higher mean intake of energy
(10.76 (2570.7) vs. 9.78 (2336.9) MJ/d (kcal/d), P < 0.001) and lower level of
protein consumption (16.9 vs. 17.6 % of energy, P < 0.001) compared with
sedentary males. In males, the association between total PA and energy intake
remained after adjustment for age, education and body mass index. Similar results
were observed when occupational activity was analysed. Concerning the energy
expended in leisure time, in both genders, after adjustment for the previously
described variables, a significant positive association was found between PA and
intake of vitamin C (g/d): beta = 0.12, 99 % confidence interval (CI) 0.02, 0.21
for females and beta = 0.13, 99 % CI 0.03, 0.22 for males. Leisure-time activity
in females was also positively associated with intakes of fibre, vitamin E,
folate, calcium and magnesium, and negatively associated with saturated fat.
CONCLUSIONS: Higher levels of PA in leisure time were associated with higher
intakes of micronutrients and lower intakes of saturated fat, particularly in
females. For total and occupational PA, similar nutrient intake was observed
between active and sedentary individuals.
PMID: 18053293 [PubMed - indexed for MEDLINE]
33. Public Health Nutr. 2007 Nov;10(11A):1389-95.
Trends in physical activity status in Catalonia, Spain (1992-2003).
Román-Viñas B, Serra-Majem L, Ribas-Barba L, Roure-Cuspinera E, Cabezas C,
Vallbona C, Plasencia A.
Community Nutrition Research Centre, University of Barcelona Science Park,
Baldiri Reixac 4, Torre D 4A1, 08028, Barcelona, Spain.
AIM: The promotion of a healthy and active lifestyle among the population is
essential for the prevention of numerous chronic diseases. Physical activity
measurement and surveillance is crucial for understanding and evaluating
campaigns to promote its practice. OBJECTIVE: To evaluate the 10-year trends in
physical activity habits in the Catalan population. DESIGN: Two cross-sectional
nutritional surveys were carried out within a 10-year interval in the population
of Catalonia. Data on physical activity include leisure-time physical activity,
occupational physical activity and walking activity and regular stair climbing.
SubjectIn all, 2344 individuals participated in the ENCAT 1992-93 study and 2055
individuals in the ENCAT 2002-03 survey, aged 10 to 75 years. RESULTS: Inactivity
related to occupation increased (from 53% in 1992-93 to 56% in 2002-03 of the
Catalan population having sedentary work-related activities). In both genders,
the percentage of people who walked to work at least 30 min decreased (from 19%
to 16% in men and from 25% to 19% in women). There was a decrease in the
percentage of people who were completely sedentary during leisure time (from 59%
to 56%), and an increase in the percentage of people who did at least 2 days of
vigorous activity (from 39% to 46% in men and from 26% to 32% in women).
CONCLUSIONS: The physical activity related to work and transportation has
decreased during the period observed. Although a slight improvement has been
noted, the percentage of people who are sedentary during leisure time is still
high among both men and women.
PMID: 17988410 [PubMed - indexed for MEDLINE]
34. BMC Public Health. 2007 Oct 18;7:294.
Consistency between education reported in health survey and recorded in death
certificate.
Khang YH, Kim HR, Lynch JW.
Department of Preventive Medicine, University of Ulsan College of Medicine,
Seoul, Korea. youngk@amc.seoul.kr
BACKGROUND: Education level is one indicator of socioeconomic position which, in
several countries including South Korea, is provided though death certificate
data. Its validity determines the usefulness of death certificate data for
exploring the association between socioeconomic position and mortality. This
study was to compare education recorded on the death certificate with that
reported before death in a nationally representative cohort of participants in
the National Health and Nutrition Examination Survey (NHANES). METHODS: The
1998/2001 NHANES data contained unique 13-digit personal identification numbers
that were individually linked to death certificate data from the Korean National
Statistical Office. Duration of mortality follow-up was 7.1 years. The data from
513 deaths were used to determine sensitivity and specificity of education in
death certificate and estimate agreement rates of education level between NHANES
data and death certificate data. Odds ratios for agreement in education were also
estimated. Covariates considered in the analyses were gender, age, duration
between NHANES and death, and cause of death. RESULTS: The proportion of deaths
without recorded education in death certificate was very low (0.2%). A total of
29.4% discordant pairs were found. Sensitivity and specificity for college or
higher education were 0.84 (95% confidence interval 0.71-0.97) and 0.99
(0.98-1.00). However, sensitivity was poor for middle school education. The
overall agreement rate was 70.7% (66.8%-74.6%) when education was categorized
into five groups and increased up to 88.9% (86.2%-91.6%) when three education
categories were used. The magnitude of validity and reliability for education did
not generally vary with age, duration between health survey and death, and cause
of death. However, a significantly smaller likelihood of agreement was found for
middle and elementary school education after adjusting for covariates.
CONCLUSION: Low percentage of missing information on education in South Korean
death certificate data could provide a great potential to monitor mortality
inequalities. A more collapsed categorization in education would be recommended
when a more definitive conclusion on educational mortality inequality is
required.
PMCID: PMC2175513
PMID: 17941999 [PubMed - indexed for MEDLINE]
35. Obes Rev. 2008 Jan;9(1):4-10. Epub 2007 Oct 11.
Prevalence of obesity in 6- and 9-year-old children living in Central-North
Italy. Analysis of determinants and indicators of risk of overweight.
Albertini A, Tripodi A, Fabbri A, Mattioli M, Cavrini G, Cecchetti R, Dalle Donne
E, Cortesi C, De Giorgi S, Contarini V, Andreotti L, Veronesi B, Stefanelli I, Di
Martino E.
Nutrition and Food Health Services, Nutritional team, Region of Emilia-Romagna,
Modena, Italy.
The objective of our article is to survey the prevalence of overweight and
obesity among 6- and 9-year-old children in Emilia-Romagna, a region of
Central-North Italy, and to study the eating habits and behaviours of these
children and their families. During 2003 and 2005, we analysed a stratified
sample of the general population of children attending pre-school (2681 children
aged 6 years) and primary school (2955 children aged 9 years). Their height and
weight were measured by healthcare workers. In the 6-year-old children,
information concerning their eating habits was collected by means of a
questionnaire completed by their parents. The prevalence of overweight was 16.5%
in 6-year-old children and 20.6% in 9-year-old children. The increase of
overweight from 6- to 9-year-old children was observed in males (13.5% in
6-year-old/21.3% in 9-year-old boys), but not in females. The prevalence of
obesity was 8.9% in children aged 6 years and 9.0% in those aged 9 years, and it
was higher in comparison with Italian surveys carried out in 1993 and in 2001:
7.5% in 6-year-old and 7.8% in 9-year-old children in 1993, and 6.6% in
6-year-old and 7.2% in 9-year-old children in 2001. In pre-school children,
overweight and obesity were closely influenced by the education level, occupation
and nutritional status of the parents.
PMID: 17931348 [PubMed - indexed for MEDLINE]
36. Food Nutr Bull. 2007 Mar;28(1):59-66.
Economic inequality and undernutrition in women: multilevel analysis of
individual, household, and community levels in Cambodia.
Hong R, Hong R.
Department of Global Health, School of Public Health and Health Services, George
Washington University, 2175 K Street NW, Washington, DC 20037, USA. rhong@gwu.edu
BACKGROUND: Many people in developing countries are still struggling to emerge
from the realm of extreme poverty, where economic improvements tend to benefit a
small, affluent group of the population and cause growing inequality in health
and nutrition that affects the most vulnerable groups of the population,
including women and children. OBJECTIVE: To examine how household and community
economic inequality affects nutritional status in women using information on
6,922 nonpregnant women aged 15 to 49 years included in the 2000 Cambodia
Demographic and Health Survey. METHODS: Nutritional status is defined with the
use of the body-mass index (BMI). BMI less than 18.5 kg/m2 is defined as
undernourishment. The household wealth index was calculated from household
ownership of durable assets and household characteristics. Community wealth is an
average household wealth index at the community level. Household and community
economic inequalities were measured by dividing the wealth index into quintiles.
The effects of household and community economic inequality were estimated by
multilevel analysis. RESULTS: Independently of community economic status and
other risk factors, women in the poorest 20% of households are more likely to be
undernourished than women in the richest 20% of households (RR = 1.63; p = .008).
The results also show variation among communities in the nutritional status of
women. Age, occupation, and access to safe sources of drinking water are
significantly associated with women's nutritional status. CONCLUSIONS: Improving
household income and creating employment opportunities for women, in particular
poor women, may be a key to improving the nutritional status of women in
Cambodia.
PMID: 17718013 [PubMed - indexed for MEDLINE]
37. Environ Health Perspect. 2007 Aug;115(8):1197-203.
Relationships of thyroid hormones with polychlorinated biphenyls, dioxins,
furans, and DDE in adults.
Turyk ME, Anderson HA, Persky VW.
Division of Epidemiology and Biostatistics, School of Public Health, University
of Illinois at Chicago, Chicago, Illinois 60612, USA. mturyk1@uic.edu
BACKGROUND: Thyroid hormone homeostasis can be disrupted by exposure to
ubiquitous and bioaccumulative organochlorines such as polychlorinated biphenyls
(PCBs) and polychlorinated dibenzo-p-dioxins (PCDDs). Whereas investigations of
health effects have generally focused on human populations with relatively high
exposures through occupation, accident, or high fish consumption, general
population exposures may also carry risk. METHODS: We studied associations of
total thyroxine (T(4)) and thyroid-stimulating hormone (TSH) with PCBs,
dioxin-like toxic equivalents (TEQs), and p,p'-diphenyldichloroethene (DDE) in
adult participants without thyroid disease who participated in the 1999-2002
National Health and Nutrition Examination Survey, a cross-sectional survey
examining a random sample representative of the U.S. population. RESULTS: We
found inverse associations of total T(4) with exposure to TEQs in both sexes,
with stronger associations in females. In women, mean T(4) was 8.2 microg/dL, and
levels were on average 0.75 microg/dL lower (95% confidence interval, 0.04-1.46)
in women in the highest quintile of TEQ exposure compared with the lowest two
quintiles. Effects were stronger in people > 60 years of age, with negative
associations of T(4) with PCBs and TEQs, and positive associations of TSH with
PCBs and TEQs in older women, and a negative association of TSH with PCBs in
older men. CONCLUSIONS: The data show a dose-dependent decrease in total T(4)
with exposure to TEQs at levels similar to those found in the general U.S.
population. The effects were stronger in women. The results suggest that older
adults, who have a high risk of thyroid disease, may be more at risk for
disruption of thyroid hormone homeostasis by dioxin-like organochlorines than
younger adults.
PMCID: PMC1940071
PMID: 17687447 [PubMed - indexed for MEDLINE]
38. J Nutr Sci Vitaminol (Tokyo). 2007 Apr;53(2):109-16.
The application of a handheld personal digital assistant with camera and mobile
phone card (Wellnavi) to the general population in a dietary survey.
Kikunaga S, Tin T, Ishibashi G, Wang DH, Kira S.
Faculty of Sciences of Human Life, Notre Dame Seishin University, 2-16-9
Ifuku-cho, Okayama 700-8516, Japan. kikunaga@post.ndsu.ac.jp
This study was carried out to examine first, the validity of a new dietary
assessment method, a handheld personal digital assistant with camera and mobile
phone card (Wellnavi), in comparison with a weighed diet record as a reference
method and second, the relation between obesity and underreporting in the
Wellnavi method in 27 men and 48 women volunteers aged 30-67 y from the general
population. On the validity, there were significant correlations (0.32-0.75)
between the daily nutrient intakes measured by the Wellnavi method and the
weighed diet record method in all the subjects except for some nutrients such as
iron, magnesium and vitamin E. Results similar to those from the group of all the
subjects were obtained in the men's group and the women's group. In all the
subjects and the men's group and the women's group, the differences in the daily
nutrient intakes between the two dietary assessment methods were statistically
significant. However, good agreement of the differences between the two dietary
assessment methods for many daily nutrient intakes was obtained in the nonobese
men. The nutrient intakes estimated by the Wellnavi method in all the subjects
and the men's group and the women's group were significantly lower than those
values estimated by the weighed diet record method except for some nutrients such
as sodium, iron and fat-soluble vitamins. With respect to the relation between
obesity and underreporting, the obesity in women was not a factor of
underreporting in the Wellnavi method, but the presence of this relation was
undeniable in the obese men. The reason why the values of daily nutrient intakes
in the Wellnavi method were lower than those estimated by the weighed diet record
method seemed to be the low quality of the digital photo of the Wellnavi
instrument. By improving the digital photo quality of this instrument, the
Wellnavi method could become a useful new dietary assessment method to get
accurate dietary information from people of a wide range of age and occupation,
and a wide variety of physical situations of subjects from the general
population.
PMID: 17615997 [PubMed - indexed for MEDLINE]
39. Am J Respir Crit Care Med. 2007 Aug 1;176(3):306-13. Epub 2007 May 16.
Nontuberculous mycobacterial sensitization in the United States: national trends
over three decades.
Khan K, Wang J, Marras TK.
Department of Medicine, University of Toronto, Toronto, Canada.
RATIONALE: The prevalence of pulmonary nontuberculous mycobacterial (NTM)
infections in the United States appears to be rising, but it is unclear if this
is due to enhanced detection or actual increases in the burden of infection.
Temporal changes in the epidemiology of Mycobacterium intracellulare
sensitization may help explain recently observed trends in pulmonary NTM
infections. OBJECTIVES: Describe the epidemiology of M. intracellulare
sensitization in the United States in 1971-1972 and 1999-2000. METHODS: We
studied nationally representative cohorts of the United States'
noninstitutionalized civilian population participating in the 1971-1972 and
1999-2000 National Health and Nutrition Examination Surveys (NHANES).
Participants were skin tested with M. intracellulare antigen and sensitization
prevalence was compared across NHANES surveys and between participant subgroups.
Logistic regression was used to identify associations between participant
characteristics, environmental factors, and NTM sensitization. MEASUREMENTS AND
MAIN RESULTS: The 1971-1972 and 1999-2000 NHANES cohorts included 1,490 and 7,384
individuals, respectively. Between 1971-1972 and 1999-2000, the prevalence of M.
intracellulare sensitization increased from 11.2% (95% confidence interval,
9.2-13.5%) to 16.6% (95% confidence interval, 13.2-20.6%). On multivariate
analysis of the 1999-2000 cohort, age, sex, race, birthplace, education, and
occupation were strongly associated with M. intracellulare sensitization.
CONCLUSIONS: In 1999-2000, an estimated one in six persons in the United States
demonstrated M. intracellulare sensitization, up from one in nine persons in
1971-1972. The observed rising prevalence of sensitization is consistent with
observed increases in the rates of pulmonary NTM infections in the United States.
PMID: 17507546 [PubMed - indexed for MEDLINE]
40. Br J Nutr. 2007 May;97(5):987-92.
Comparative whole-grain intake of British adults in 1986-7 and 2000-1.
Thane CW, Jones AR, Stephen AM, Seal CJ, Jebb SA.
MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road,
Cambridge CB1 9NL, UK. Christopher.Thane@mrc-hnr.cam.ac.uk
Epidemiological evidence suggests that higher consumption of whole-grain foods
can significantly reduce the risk of chronic diseases such as CVD, type 2
diabetes and some cancers. The present study compares whole-grain intake of 2086
adults aged 16-64 years from the 1986-7 Dietary and Nutritional Survey of British
Adults with that of 1692 adults aged 19-64 years from the 2000-1 National Diet
and Nutrition Survey. For each survey, whole-grain intake was estimated from
consumption of all foods containing > or = 10% whole-grain content (as DM/fresh
weight of food) from 7d weighed dietary records. In 1986-7, median whole-grain
intake was 16 (interquartile range 0-45) g/d v. 14 (interquartile range 0-36) g/d
in 2000-1 (P< 0.001). In 1986-7, 77% of adults had less than three 16 g amounts
of whole-grain intake/d; 25 % reported no whole-grain intake. In 2000-1,
corresponding percentages were 84 and 29%, respectively. Foods with <51%
whole-grain content provided 18% of whole-grain intake in 1986-7 v. 27% in 2000-1
(P<0.001). In both surveys, whole-grain intake was significantly lower among
adults with a manual v. non-manual occupation (indicative of lower socio-economic
status) and among smokers v. non-smokers, independent of occupational social
class. In 1986-7, whole-grain breakfast cereals and wholemeal bread contributed
28 and 48% of whole-grain intake, respectively, v. 45 and 31% in 2000-1. At each
time, one-third of adults consumed neither of these two largest contributors to
whole-grain intake. Findings from the present study suggest that whole-grain
intake of British adults was low in 1986-7 and became even lower over the
subsequent decade.
PMID: 17381971 [PubMed - indexed for MEDLINE]
41. Public Health Nutr. 2007 Feb;10(2):115-21.
Trends in overweight by socio-economic status in Vietnam: 1992 to 2002.
Nguyen MD, Beresford SA, Drewnowski A.
National Institute of Nutrition of Vietnam, Hanoi, Vietnam.
OBJECTIVE: To explore socio-economic factors associated with rising rates of
overweight among Vietnamese adults. DESIGN: The study was based on three national
surveys of socio-economic factors and health conducted over a 10-year period. The
studies were: the Vietnamese Living Standard Survey 1992-1993 (11 982
participants); the Vietnamese Living Standard Survey 1997-1998 (15 975
participants); and the Vietnamese National Health Survey 2001-2002 (94 656
participants). SUBJECTS: Male and female adults >18 years old were stratified by
gender, age group, area of residence, occupation, education and relative food
expenditures. Overweight was defined using body mass index (BMI) > or = 25 kg
m(-2). RESULTS: Overweight rates in Vietnam more than doubled between 1992 and
2002 (from 2.0 to 5.7%). Significant increases were observed for men and women,
in urban and rural areas, and for all age groups. In univariate analyses, both
age and higher socio-economic status were associated with higher rates of
overweight. Using the most recent survey, urban populations were more likely to
be overweight than rural ones (odds ratio (OR) = 1.79), white-collar workers were
more likely to be overweight than manual labourers (OR = 1.95) and persons in the
top level of food expenditures were more likely to be overweight than persons in
the bottom level (OR = 4.96) after adjustment for other factors. Education was
inversely associated with overweight after adjusting for covariates. CONCLUSION:
Economic growth and improved standard of living are associated with higher rates
of overweight in nations in early stages of economic development. In Vietnam,
higher rates of overweight were observed among the higher income and occupation
groups.
PMID: 17261219 [PubMed - indexed for MEDLINE]
42. Obesity (Silver Spring). 2006 Nov;14(11):2080-8.
Converging prevalences of obesity across educational groups in Switzerland.
Wolff H, Delhumeau C, Beer-Borst S, Golay A, Costanza MC, Morabia A.
Division of Clinical Epidemiology, Geneva University Hospitals, 25 rue
Micheli-du-Crest, 1211 Geneva 14, Switzerland. hans.wolff@hcuge.ch
OBJECTIVE: To assess whether the rapid increase in obesity prevalence among
persons with higher education levels observed in one U.S. study is also observed
in a European adult population. RESEARCH METHODS AND PROCEDURES: This study
involved continuous surveillance of the adult population of Geneva, Switzerland
(1993 to 2004), with annual random, independent, cross-sectional, representative
samples (6635 men and 6558 women, ages 35 to 74 years) and analysis of 12-year
trends in obesity prevalence across educational level subgroups. RESULTS: Obesity
prevalence in men had an upward trend in the medium education subgroup (p <
0.02), a borderline upward trend in the high education subgroup (p < 0.08), but
no trend in the low education subgroup. There was a borderline trend interaction
between the male low and medium education subgroups (p < 0.09). Obesity
prevalence in women had a borderline increase in the low education subgroup (p <
0.08), an almost borderline increase in the high education subgroup (p = 0.11),
but no significant trend in the medium education subgroup. There was no evidence
of trend interaction between the female education groups. DISCUSSION: In Geneva,
as in the United States, the inverse association between education level and
obesity rates has weakened over time among men, but, inconsistent with the U.S.
findings, has persisted for women. Explanations may include more physically
demanding occupations for men with low education levels and different attitudes
toward body image between the sexes.
PMID: 17135626 [PubMed - indexed for MEDLINE]
43. J Occup Environ Med. 2006 Nov;48(11):1143-8.
Is participation in occupational physical activity associated with lifestyle
physical activity levels?
Kruger J, Yore MM, Ainsworth BE, Macera CA.
Division of Nutrition and Physical Activity, Centers for Disease Control and
Prevention, 4770 Buford Highway NE, Atlanta, GA 30341, USA. ezk0@cdc.gov
OBJECTIVE: Little is known about the prevalence of lifestyle physical activity
(PA) by occupational PA (mostly sitting, walking, or heavy labor). METHODS:
Descriptive and adjusted multivariable logistic regression analysis of lifestyle
PA (regularly active, irregularly active, inactive) and occupational activity was
used (N = 6,360). RESULTS: The prevalence of regular lifestyle activity was 45.7%
among those who sit/stand, 49.6% among walkers, and 59.7% among heavy laborers.
The regression analysis showed that adults working in heavy labor were almost
twice as likely to be regularly active as those who sit/stand. CONCLUSION:
Contrary to expectation, adults who engage in physically demanding work appear to
be more active outside the job. Those who are sedentary at work could benefit
from having access to opportunities for PA during the workday and trying to
engage in activity outside of work hours.
PMID: 17099450 [PubMed - indexed for MEDLINE]
44. Indian J Med Res. 2006 Aug;124(2):173-84.
Prevalence of anaemia in pregnant & lactating women in India.
Agarwal KN, Agarwal DK, Sharma A, Sharma K, Prasad K, Kalita MC, Khetarpaul N,
Kapoor AC, Vijayalekshmi L, Govilla AK, Panda SM, Kumari P.
Healthcare & Research Association for Adolescents, Noida, New Delhi, India.
adolcare@hotmail.com
Comment in:
Indian J Med Res. 2007 Jun;125(6):794.
Indian J Med Res. 2007 Jan;125(1):99-101; author reply 101.
BACKGROUND & OBJECTIVES: The prevalence of anaemia during pregnancy and lactation
was significantly lower in the National Family Health Survey 1998-1999 (NFHS-2),
using the hemocue method for haemoglobin estimation compared to earlier surveys.
The present study selected seven States and used the same districts and villages
studied in the NFHS-2, to see if the reported reduction in prevalence of anaemia
was due to health and nutrition inputs and/or due to a different method for
haemoglobin estimation. METHODS: A total of 1,751 women (1,148 pregnant and 603
lactating- exclusively breastfeeding up to 3 months of age), from seven States-
Himachal Pradesh and Haryana in north; Assam and Orissa in east; Kerala and Tamil
Nadu in south and Madhya Pradesh in central India, were selected. Haemoglobin was
estimated by the cyanmethaemoglobin method, so that comparison was possible with
earlier studies. Data on socio-demographic characteristics, pregnancy,
nutritional status and dietary intakes were collected. RESULTS: Prevalence as
well as severity of anaemia was significantly higher in the present study as
compared to the NFHS-2 study data. The difference could be due to haemocue
method, which gives higher haemoglobin values. The contributing factors found on
multiple regression analysis for anaemia in pregnancy and lactation were:
literacy, occupation and standard living index of the study women; their
awareness about anaemia, its prevention by regular consumption of ironfolate
tablets and increase in food intake. Maternal height, age of marriage, parity and
foetal loss also contributed to haemoglobin level. There were interstate
differences; lower fertility, higher literacy and better diet was observed in
Himachal Pradesh as compared to Haryana. The literacy and nutritional status of
women in Tamil Nadu was lower than Kerala. The remaining 3 states had poor
fertility, lower social living index and nutritional status with >90 per cent
women being anaemic in pregnancy and lactation. Low prevalence of severe anaemia
in Orissa as compared to Assam was due to availability and consumption of iron
folate tablets. The antenatal services in the first trimester and checkup by a
doctor, along with availability and consumption of iron folate tablets over 3
months in all the States influenced haemoglobin levels. INTERPRETATION &
CONCLUSION: Despite the measures taken to control anaemia in pregnancy and
lactation in the last two decades, the severity of nutritional anaemia continues
to remain a public health issue of great magnitude, suggesting that these
measures have been largely ineffective. The present findings also showed
interstate differences particularly in fertility, women education, nutrition
status and occupation; availability of antenatal services and iron folate tablets
as possible factors responsible for differences in prevalence of anaemia.
PMID: 17015931 [PubMed - indexed for MEDLINE]
45. J Rheumatol. 2006 Nov;33(11):2271-9. Epub 2006 Oct 1.
Prevalence of knee osteoarthritis in the United States: arthritis data from the
Third National Health and Nutrition Examination Survey 1991-94.
Dillon CF, Rasch EK, Gu Q, Hirsch R.
Division of Health and Nutrition Examination Statistics, National Center for
Health Statistics, DHANES, 3311 Toledo Road, Hyattsville, MD 20782, USA.
cid2@cdc.gov
Comment in:
J Rheumatol. 2006 Nov;33(11):2110-2.
OBJECTIVE: To estimate the US national prevalence of tibiofemoral radiographic
knee osteoarthritis (RKOA) with and without symptoms, and its influence on
functional tasks. METHODS: Radiographic and interview data from the National
Health and Nutrition Examination Survey (NHANES III), a nationally representative
cross-sectional health examination survey, were used to estimate lifetime RKOA
prevalence in adults age 60 years and older. Demographic trends, self-reported
activity limitations, physical performance test results, and patterns of recent
analgesic use were analyzed. RESULTS: Among US adults, the prevalence of RKOA and
symptomatic RKOA was 37.4% and 12.1%, respectively. RKOA prevalence was greater
among women than men (42.1% vs 31.2%). Women had significantly more
Kellgren-Lawrence Grade 3-4 changes (12.9% vs 6.5% in men). However, symptomatic
RKOA prevalence did not differ by sex. Additionally, some 1.6% of US adults had
knee joint replacement. Multivariable analysis showed significantly higher odds
of both RKOA and symptomatic RKOA with greater body mass index (BMI > or = 30),
greater age, non-Hispanic Black race/ethnicity, and among men with manual labor
occupations. Only symptomatic RKOA was significantly associated with
self-reported activity limitations: difficulty walking, stooping, standing from a
seated position, and stair climbing. Adults with symptomatic RKOA used
significantly more assistive walking devices, had slower measured gait
velocities, and used significantly more prescription nonsteroidal
antiinflammatory drugs and prescription narcotics, and nonprescription
acetaminophen. CONCLUSION: NHANES III data provide an overall national assessment
of the prevalence, demographic distributions, and functional impact of
symptomatic knee OA, which affects more than 1 in 10, or 4.3 million older US
adults.
PMID: 17013996 [PubMed - indexed for MEDLINE]
46. N Z Med J. 2006 Aug 18;119(1240):U2127.
Dietary intakes by different markers of socioeconomic status: results of a New
Zealand workforce survey.
Metcalf P, Scragg R, Davis P.
Department of Statistics, University of Auckland, Auckland.
p.metcalf@auckland.ac.nz
AIM: To compare dietary nutrient and food group intakes of men and women in a
work force with various measures of socioeconomic status. METHODS: Daily nutrient
intakes were calculated from a self-administered food frequency questionnaire
from participants in a cross-sectional health screening survey of a multiracial
workforce carried out between May 1988 and April 1990. Participants comprised
5517 Maori, Pacific Island and Other workers (3997 men, 1520 women) aged 40 to 78
years. Socioeconomic measures included the New Zealand Socioeconomic Index
(NZSEI), gross household income and level of education. RESULTS: In general,
there were trends across socioeconomic status levels with lower NZSEI
occupational classes, lower family income, and non-tertiary education groups
having lower intakes of dietary fibre, calcium, and alcohol and higher intakes of
dietary cholesterol. These were reflected by their lower intakes of fruit,
vegetables, milk, cheese and wine, and higher intakes of eggs. However,
associations were not consistent across all measures of socioeconomic status.
CONCLUSIONS: Dietary intakes showed a generally more adverse pattern in the lower
socioeconomic strata. NZSEI and education were associated with food group
selections, whereas nutrient intakes were associated with income. More money
available for food could improve nutrition. Public health programmes to improve
nutrition need to be targeted at these groups and be coupled with personal
support and structural changes that make "healthy choices the easy choices".
PMID: 16924278 [PubMed - indexed for MEDLINE]
47. Maturitas. 2007 Jan 20;56(1):1-11. Epub 2006 Jun 27.
Impact of seafood and fruit consumption on bone mineral density.
Zalloua PA, Hsu YH, Terwedow H, Zang T, Wu D, Tang G, Li Z, Hong X, Azar ST, Wang
B, Bouxsein ML, Brain J, Cummings SR, Rosen CJ, Xu X.
Program for Population Genetics, Harvard School of Public Health, Boston, MA,
USA.
OBJECTIVES: Over the past decade, dietary choices and nutrition have proven to be
major modulators of bone mineral density (BMD) in men and women. We investigated
environmental determinants, specifically dietary habits, of BMD by using multiple
regression models in a rural Chinese population. METHODS: BMDs were measured at
the hip and total body in 5848 men and 6207 women, aged 25-64. Dietary and
supplemental intakes were assessed by a simple, one-page questionnaire tailored
to collect nutritional information from large rural populations. Another
questionnaire was used to collect information on the subjects' age, disease
history, smoking, alcohol consumption, physical activity as well as women's
menstrual status and reproductive history. Multiple regression models were used
to assess the relationships among dietary variables and BMD, after adjusting for
age, BMI (body mass index), weight, occupation, smoking status, and alcohol
consumption. RESULTS: Increasing seafood consumption was significantly associated
with greater BMD in women (p<0.001), especially those consuming more than 250 g
per week of seafood. One thousand and three hundred and twenty-four men and 1479
women consumed >250 g of fruit per week. Higher fruit intake was found to be
significantly associated with higher BMD in both sexes (p<0.05). High vegetable
consumption, however, did not positively impact BMD. CONCLUSIONS: This study with
its large population size has identified preventive measures, as well as some
risk factors, involved in bone loss and osteoporosis. Our results highlight the
importance of several dietary variables as significant determinants of BMD. It
also emphasizes the role of dietary intake in general and shows that specific
foods, such as fruits and seafood, can positively impact BMD.
PMID: 16806750 [PubMed - indexed for MEDLINE]
48. Public Health Nutr. 2006 May;9(3):394-402.
The effect of personal characteristics on the validity of nutrient intake
estimates using a food-frequency questionnaire.
Marks GC, Hughes MC, van der Pols JC.
Queensland Institute of Medical Research, Herston, Queensland 4029, Australia.
g.marks@sph.uq.edu.au
OBJECTIVE: To assess validity of the Nambour food-frequency questionnaire (FFQ)
relative to weighed food records (WFRs), and the extent to which selected
demographic, anthropometric and social characteristics explain differences
between the two dietary methods.DESIGN: Inter-method validity study; 129-item FFQ
vs. 12 days of WFR over 12 months.SETTING: Community-based Nambour Skin Cancer
Prevention Trial.SUBJECTS: One hundred and fifteen of 168 randomly selected
participants in the trial (68% acceptance rate) aged 25-75 years.RESULTS:
Spearman correlations between intakes from the two methods ranged from 0.18 to
0.71 for energy-adjusted values. Differences between FFQ and WFR regressed on
personal characteristics were significantly associated with at least one
characteristic for 16 of the 21 nutrients. Sex was significantly associated with
differences for nine nutrients; body mass index (BMI), presence of any medical
condition and age were each significantly associated with differences for three
to six nutrients; use of dietary supplements and occupation were associated with
differences for one nutrient each. There was no consistency in the direction of
the significant associations. Regression models explained from 7% (riboflavin) to
27% (saturated fat) of variation in differences in intakes.CONCLUSIONS: The
relative validity of FFQ estimates for many nutrients is quite different for
males than for females. Age, BMI, medical condition and level of intake were also
associated with relative validity for some nutrients, resulting in the need to
adjust intakes estimates for these in modelling diet-disease relationships.
Estimates for cholesterol, beta-carotene equivalents, retinol equivalents,
thiamine, riboflavin and calcium would not benefit from this.
PMID: 16684392 [PubMed - indexed for MEDLINE]
49. Asia Pac J Clin Nutr. 2006;15(2):245-52.
Fruits and vegetables, 5+ a day: are we getting the message across?
Ashfield-Watt PA.
Institute of Food, Nutrition and Human Health, Massey University, NSMC, Private
Bag 102 904, Auckland, New Zealand. p.ashfield-watt@massey.ac.nz
Fruit and vegetables have important health promoting properties. The 5+ a day
programme aims to promote awareness of the need to eat more of these foods. This
paper presents and discusses the results of two surveys designed to determine the
success of the 5+ a day programme across New Zealand. Household surveys were
carried out by a marketing research company in 1999 and 2000. The 1999
questionnaire focused on awareness and understanding of the 5+ a day campaign.
The 2000 questionnaire focused on attitudes to health and on intakes of fruits
and vegetables. Data were collected from households nationwide (1999 survey N =
200, 2000 survey N = 520). Spontaneous consumer awareness of messages promoting
the need to eat more fruit and vegetables was high. Seventy-one percent of all
respondents identified the 5 servings a day message from the 5+ a day logo
regardless of whether they had seen it before. The meaning of the hand in the
logo was less clear with only 2.5% identifying the 'serving size' element of the
logo. Fruit and vegetable intakes of respondents were influenced by demographic
factors: gender, ethnicity, education and occupation (all P < or = 0.05).
Positive attitude towards the relationship between fruit, vegetables and health
was influenced by similar factors and in turn affected fruit and vegetable
intakes. The 5+ a day message is well recognised and understood. Portion size is
less well understood. The 5+ a day message promotes positive attitudes towards
healthy eating which are associated with healthier eating habits, but some groups
within society may need further attention.
PMID: 16672211 [PubMed - indexed for MEDLINE]
50. J Epidemiol. 2006 Mar;16(2):79-89.
Job strain, worksite support, and nutrient intake among employed Japanese men and
women.
Kawakami N, Tsutsumi A, Haratani T, Kobayashi F, Ishizaki M, Hayashi T, Fujita O,
Aizawa Y, Miyazaki S, Hiro H, Masumoto T, Hashimoto S, Araki S.
Hygiene and Preventive Medicine, Okayama University Graduate School of Medicine,
Dentistry & Pharmaceutical Sciences, Okayama, Japan. norito@md.okayama-u.ac.jp
Comment in:
J Epidemiol. 2006 Sep;16(5):220; author reply 221.
BACKGROUND: The association of job strain (as defined by the job demands/control
model) and worksite support with nutrient intake is not clear. METHODS: A
questionnaire survey was conducted of 25,104 workers employed in nine companies
in Japan. Job strain and worksite support were assessed using the Job Content
Questionnaire. Daily intake of 17 nutrients was measured using a dietary history
questionnaire. Data from 15,295 men and 2,853 women were analyzed, controlling
for age, education, marital status, occupation, and study site. RESULTS: Among
men, job strain was positively associated with average daily intakes of fat,
vitamin E, cholesterol, poly- and mono-unsaturated fatty acids (p for
trend<0.05), and worksite support was positively associated with average daily
intakes of total energy, crude fiber, retinol, carotene, vitamins A, C, and E,
cholesterol, and saturated fatty acid (p for trend<0.05). Among women, worksite
support was positively associated with average daily intakes of total energy,
protein, vitamin E, and polyunsaturated fatty acid (p for trend<0.05). However
these differences were generally small. CONCLUSIONS: The present study showed
that job strain and worksite support were only weakly and inconsistently
associated with nutritional intakes. It does not seem that changes in nutritional
intakes explain the association between job strain or worksite support and
coronary heart disease.
PMID: 16537988 [PubMed - indexed for MEDLINE]
51. Asia Pac J Clin Nutr. 2006;15(1):64-71.
Diet and nutritional status of adolescent tribal population in nine states of
India.
Rao KM, Balakrishna N, Laxmaiah A, Venkaiah K, Brahmam GN.
National Institute of Nutrition, Indian Council of Medical Research,
Jamai-Osmania, Hyderabad, India. malliknin@yahoo.co.in
Tribal population constitutes about 8% of the total population in India. They are
particularly vulnerable to undernutrition, because of their geographical
isolation, socio-economic disadvantage and inadequate health facilities.
Recognizing the problem, Government of India launched different programmes for
their welfare. Adolescence is a significant period of growth and maturation. The
nutritional status of adolescent girls, the future mothers, contributes
significantly to the nutritional status of the community. Therefore an attempt
was made to assess the diet and nutritional status of adolescent population from
the different tribal areas of India. The available database collected by National
Nutrition Monitoring Bureau (1998-99) was utilized for this purpose. Data on a
total of 12,789 adolescents (10-17 yrs) was included for the analysis. Four
percent of the adolescent girls were married and less than 1% were either
pregnant (0.4%) or lactating (0.7%) at the time of the survey. The mean intake of
all the foodstuffs, especially the income elastic foods such as Pulses, Milk &
Milk products, Oils & fats and Sugar & Jaggery were lower than the recommended
levels of ICMR. The intake of all the foodstuffs except green leafy vegetables
was lower than that of their rural counterparts. The intake of all the nutrients
were below the recommended level, while that of micronutrients such as iron,
vitamin A and riboflavin were grossly inadequate in all the age and sex groups.
About 63% of adolescent boys and 42% of girls were undernourished (< 5th BMI age
percentiles of NHANES). A significant association between undernutrition and
socio-economic parameters like type of family, size of land holding and
occupation of head of household was observed. Therefore, there is a need to
evolve comprehensive programmes for the overall development of tribal population
with special focus on adolescents.
PMID: 16500880 [PubMed - indexed for MEDLINE]
52. Public Health Nutr. 2006 Feb;9(1):75-83.
A multilevel study of socio-economic inequalities in food choice behaviour and
dietary intake among the Dutch population: the GLOBE study.
Giskes K, Turrell G, van Lenthe FJ, Brug J, Mackenbach JP.
Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
k.giskes@erasmusmc.nl
OBJECTIVE: To examine the influence of individual- and area-level socio-economic
characteristics on food choice behaviour and dietary intake. SETTING: The city of
Eindhoven in the south-east Netherlands. DESIGN: A total of 1339 men and women
aged 25-79 years were sampled from 85 areas (mean number of participants per area
= 18.4, range 2-49). Information on socio-economic position (SEP) and diet was
collected by structured face-to-face interviews (response rate 80.9%).
Individual-level SEP was measured by education and household income, and
area-level deprivation was measured using a composite index that included
residents' education, occupation and employment status. Diet was measured on the
basis of (1) a grocery food index that captured compliance with dietary
guidelines, (2) breakfast consumption and (3) intakes of fruit, total fat and
saturated fat. Multilevel analyses were performed to examine the independent
effects of individual- and area-level socio-economic characteristics on the
dietary outcome variables. RESULTS: After adjusting for individual-level SEP, few
trends or significant effects of area deprivation were found for the dietary
outcomes. Significant associations were found between individual-level SEP and
food choice, breakfast consumption and fruit intake, with participants from
disadvantaged backgrounds being less likely to report food behaviours or nutrient
intakes consistent with dietary recommendations. CONCLUSIONS: The findings
suggest that an individual's socio-economic characteristics play a more important
role in shaping diet than the socio-economic characteristics of the area in which
they live. In this Dutch study, no independent influence of area-level
socio-economic characteristics on diet was detected, which contrasts with
findings from the USA, the UK and Finland.
PMID: 16480537 [PubMed - indexed for MEDLINE]
53. J Nutr. 2006 Feb;136(2):459-65.
Relative validity of food intake estimates using a food frequency questionnaire
is associated with sex, age, and other personal characteristics.
Marks GC, Hughes MC, van der Pols JC.
School of Population Health, University of Queensland, Herston, Qld 4006,
Australia. g.marks@sph.uq.edu.au
We investigated the validity of food intake estimates obtained by a
self-administered FFQ relative to weighed food records (WFR) and the extent to
which demographic, anthropometric, and social characteristics explain differences
between these methods. A community-based sample of 96 Australian adults completed
a FFQ and 12 d of WFR over 12 mo. The FFQ was adapted to the Australian setting
from the questionnaire used in the US Nurses' Health Study. Spearman rank
correlation coefficients ranged from 0.08 for "other vegetables" to 0.88 for tea.
Exact agreement by quartiles of intake ranged from 27% (eggs) to 63% (tea).
Differences between FFQ and WFR regressed on personal characteristics were
significantly associated with at least 1 characteristic for 20 of the 37 foods.
Sex was significantly associated with differences for 17 food groups, including 5
specific vegetable groups and 2 "total" fruit and vegetable groups. Use of
dietary supplements and the presence of a medical condition were associated with
differences for 5 foods; age, school leaving age, and occupation were associated
with differences for 1-3 foods. BMI was not associated with differences for any
foods. Regression models explained from 3% (whole-meal bread) to 37% (for all
cereals and products) of variation in differences between methods. We conclude
that the relative validity of intake estimates obtained by FFQ is different for
men and women for a large number of foods. These results highlight the need for
appropriate adjustment of diet-disease relations for factors affecting the
validity of food intake estimates.
PMID: 16424128 [PubMed - indexed for MEDLINE]
54. J Prev Med Public Health. 2005 Nov;38(4):443-8.
[Reliability of education and occupational class: a comparison of health survey
and death certificate data]
[Article in Korean]
Kim HR, Khang YH.
Korea Institute for Health and Social Affairs, Department of Preventive Medicine,
University of Ulsan College of Medicine.
OBJECTIVES: This study was done to evaluate the reliability of education and
occupational class between using the health survey and the death certificate
data. METHODS: The 1998 National Health and Nutrition Examination Survey (NHANES)
was conducted on a cross-sectional probability sample of South Korean households,
and it contained unique 13-digit personal identification numbers that were linked
to the data on mortality from the Korean National Statistical Office. The data
from 263 deaths were used to estimate the agreement rates and the Kappa indices
of the education and occupational class between using the NHANES data and the
death certificate data. RESULTS: The simple and weighted Kappa indices for
education were 0.60 (95% CI=0.53-0.68) and 0.73 (95% CI=0.67-0.79) respectively,
if the educational level was grouped into five categories: no-formal-education,
elementary-school, middle-school, high-school and college or over. The overall
agreement rate was 71.9% for these educational groups. The magnitude of
reliability, as measured by the overall agreement rates and Kappa indices, tended
to increase with a decrease in the educational class. The number of non-educated
people with using the death certificate data was smaller than that with using the
NHANES data. For the occupational class (manual workers, non-manual workers and
others), the Kappa index was 0.40 (95% CI=0.30-0.51), which was relatively lower
than that for the educational class. Compared with the NHANES, the number of
non-manual workers for the deceased who were aged 30-64 tended to be increased (8
to 12) when using the death certificate data, whereas the number of manual
workers tended to be decreased (59 to 41). CONCLUSIONS: The socioeconomic
inequalities in the mortality rates that were based on the previous unlinked
studies in South Korea were not due to a numerator/denominator bias. The
mortality rates for the manual workers and the no-education groups might have
been underestimated.
PMID: 16358831 [PubMed - indexed for MEDLINE]
55. Int J Epidemiol. 2006 Feb;35(1):131-8. Epub 2005 Nov 12.
Whose socioeconomic status influences a woman's obesity risk: her mother's, her
father's, or her own?
Ball K, Mishra GD.
School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria
3125 Australia. kball@deakin.edu.au
Comment in:
Int J Epidemiol. 2006 Feb;35(1):139-40.
BACKGROUND: Evidence on the relative influence of childhood vs adulthood
socioeconomic conditions on obesity risk is limited and equivocal. The objective
of this study was to investigate associations of several indicators of mothers',
fathers', and own socioeconomic status, and intergenerational social mobility,
with body mass index (BMI) and weight change in young women. METHODS: This
population-based cohort study used survey data provided by 8756 women in the
young cohort (aged 18-23 years at baseline) of the Australian Longitudinal Study
on Women's Health. In 1996 and 2000, women completed mailed surveys in which they
reported their height and weight, and their own, mother's, and father's education
and occupation. RESULTS: Multiple linear regression models showed that both
childhood and adulthood socioeconomic status were associated with women's BMI and
weight change, generally in the hypothesized (inverse) direction, but the
associations varied according to socioeconomic status and weight indicator.
Social mobility was associated with BMI (based on father's socioeconomic status)
and weight change (based on mother's socioeconomic status), but results were
slightly less consistent. CONCLUSIONS: Results suggest lasting effects of
childhood socioeconomic status on young women's weight status, independent of
adult socioeconomic status, although the effect may be attenuated among those who
are upwardly socially mobile. While the mechanisms underlying these associations
require further investigation, public health strategies aimed at preventing
obesity may need to target families of low socioeconomic status early in
children's lives.
PMID: 16284404 [PubMed - indexed for MEDLINE]
56. Zhonghua Liu Xing Bing Xue Za Zhi. 2005 Jun;26(6):408-11.
[Study on the knowledge of nutrition and related dietary behavior among
"floating" women under pregnancy]
[Article in Chinese]
Zeng G, Zhang J, Liang JZ, Zhou R, Song MY, Zhang YJ.
Huaxi Public Health School, Sichuan University, Chengdu 610041, China.
zgmu2003@126.com
OBJECTIVE: The aim of this study was to assess the knowledge, attitude, practice
(KAP) on nutrition and related influencing factors among the "floating" women
under pregnancy. METHODS: 171 subjects in Chengdu, China were surveyed
cross-sectionally by questionnaires. RESULTS: Most participants expressed a
positive attitude towards nutrition and health, however, only 25.1% of the
subjects under study had a better knowledge on nutrition and on healthy dietary
practices. Frequency of the important foods (milk, egg, soy bean, nut, seafood
etc.) intake were not enough during pregnancy. A significantly positive
correlation was found between nutrition K, A and P (r = 0.322, 0.285, 0.173; P <
0.05). Level of education among the pregnant women under mobility and occupation
of their husbands were the major contributing factors to their KAP level on
nutrition (beta = 0.248, 0.312; P < 0.01). Medical staff, dietitians and specific
books were the major sources of information on nutrition. CONCLUSION: More
educational programs were needed to improve the knowledge and dietary behavior on
nutrition to this population.
PMID: 16185448 [PubMed - indexed for MEDLINE]
57. Soz Praventivmed. 2005;50(4):206-17.
[Individualized health behavior? Social structures, peer influences and life
style as modifying factors of nutritional behavior of adolescents]
[Article in German]
Beckert-Zieglschmid C.
Institut für Kulturwissenschaften, Universität Leipzig, Deutschland.
claudia.beckert-zieglschmid@medizin.uni
OBJECTIVE: Health behaviours are often explained as being determined by health
knowledge, occupation, education and income. Yet, in increasingly individualized
societies individuals are brought to develop personal strategies of orientation
and behaviours, the later being detached from traditional status or class
membership. The present study (secondary analysis) explores to what extent health
behaviours are more or less individualized or still linked to social living
conditions. METHODS: Eating behaviours and social status are based on a 2001
questionnaire survey among 393 randomly selected adolescents from the city of
Leipzig, Germany. RESULTS: The findings show a distinct social patterning of
eating behaviours. Those patterns can be explained as part of adolescents'
lifestyles. Findings also indicate that the patterns of eating behaviours are
strongly linked to the social background of those adolescents. CONCLUSIONS: It is
concluded that for adolescents raised in deprived social conditions it is more
difficult to develop health preferences conducive for health promoting
behaviours.
PMID: 16167505 [PubMed - indexed for MEDLINE]
58. Chest. 2005 Sep;128(3):1239-44.
Mild and moderate-to-severe COPD in nonsmokers: distinct demographic profiles.
Behrendt CE.
Epidemiology, Pfizer Global Research and Development. carolynbehrendt@yahoo.com
STUDY OBJECTIVE: To investigate the risk of COPD among nonsmokers. DESIGN:
Case-control study, logistic regression analysis. SETTING: Third National Health
and Nutrition Examination Survey, from 1988 to 1994. PARTICIPANTS: Community
residents 18 to 80 years of age, of white, black, or Mexican-American ethnicity.
Nonsmokers included never-smokers and former smokers with a < 5 pack-year smoking
history who had never smoked cigars or pipes. MEASUREMENTS: COPD (FEV1/FVC < 70%)
was classified as mild (FEV1 > or = 80% predicted) or moderate to severe (FEV1 23
to 79% predicted). RESULTS: Among 13,995 examinees, 51.3 +/- 0.4% were female,
mean age was 42.2 +/- 0.4 years, 48.7 +/- 0.9% were nonsmokers, 8.8 +/- 0.3% had
mild COPD, and 4.1 +/- 0.3% had moderate-to-severe COPD [+/- SE]. One fourth of
mild and moderate-to-severe cases were nonsmokers. Among 7,526 nonsmokers, 4.7
+/- 0.3% had mild COPD (n = 403; age, 60.9 +/- 1.3 years) and were mostly female
(82.5%), while 1.9 +/- 0.3% had moderate-to-severe COPD (n = 92, age 39.3 +/-
1.3) and were mostly male (88.1%). Few nonsmokers with COPD (12.1 +/- 2.4%) had a
previous diagnosis of chronic bronchitis or emphysema. Among nonsmokers,
physician-diagnosed asthma increased the risk of mild and especially of
moderate-to-severe COPD. Independently of asthma, risk of mild COPD in nonsmokers
increased with age (doubling every 12 years), before age 60 was lower among men
than women, and was inversely associated with current exposure to tobacco smoke
at home and at work. In contrast, the risk of moderate-to-severe COPD in
nonsmokers was markedly associated with male gender, peaked in middle age, and
was inversely associated with nonwhite ethnicity. COPD risks did not vary by
minimal smoking history, longest-held occupation, urban residence, income,
allergies, thyroid disease, or Helicobacter pylori antibody. CONCLUSIONS: Among
nonsmokers, mild and moderate-to-severe COPD are associated with asthma but
otherwise have distinct demographic profiles, suggesting that moderate-to-severe
disease is not a mere progression of mild COPD.
PMID: 16162712 [PubMed - indexed for MEDLINE]
59. Zhonghua Liu Xing Bing Xue Za Zhi. 2005 Apr;26(4):246-51.
[Study on diet, physical activities and body mass index in Chinese population in
2002]
[Article in Chinese]
Yang GH, Ma JM, Liu N, Chen AP.
Institute of Basic Medical Sciences, Peking Union Medical College, Chinese
Academy of Medical Sciences, Beijing 100005, China.
OBJECTIVE: To describe the prevalence of behavior on diet, physical activities
and body mass index (BMI) in different populations related to factors as
education, occupation and geographical distribution. METHODS: Indicators
including frequency of taking different foods, intake of cooking oil/fast foods,
intensities of physical activities at work, proportion of taking physical
exercises during the day, sedentary life style and BMI were calculated based on
results from 17 questions of behavior risk factors surveillance (BRFS)
questionnaire by weight on age structures from 2000 census. RESULTS: Seventy
percentage of the people took vegetable and 40 percent took fruits 5-7 days per
week, and over 50 percent of them ate pork/beef/mutton but few of them ate beans
and eggs. 25 percent of the people ate chicken/duck/fish/and shrimps 5-7 times
per week but another 40 percent ate them only less then once per week. 70% of the
people almost never drank milk or milk-products. 15 percent of them consumed
sweet and greasy foods 3-7 days per week and 30 percent of them ate smoked food
3-7 days per week in the past 30 days. The proportions of food intake were
different under different geographical regions, education levels and occupations.
11.7% of the sample population cooked mainly with animal oil, and 33% of the
students had ever been to McDonald's. 11.7%, 20.5%, 44.7% and 23.0% of the
subjects engaged in sedentary, light, moderate or heavy physical activities
respectively. 18.04% of the subjects took part in physical exercises with
different proportions by gender, occupation, education and geographical settings.
8.3% people were slim which was defined as having BMI lower than 18.5 kg/m(2).
68.0% of the people had a BMI as 18.5-23.9 kg/m(2). 23.7% of the subjects were
being overweight which was defined as having BMI greater than 24 kg/m(2), among
which 8.5% people with a BMI of 24-24.9 kg/m(2). CONCLUSION: The prevalence of
overweight and obesity will increase in the next 20-30 years, with the habits of
taking more foods with high fat and energy but with less physical activities and
keeping the idea as "fattier makes happier". Priorities should be given to
changing the diet habit, avoiding over-intake of high fat and high energy plus
increasing physical activities through publicity of knowledge on health, policy
enforcement and development of supportive environment.
PMID: 15941528 [PubMed - indexed for MEDLINE]
60. Obes Res. 2004 Dec;12(12):1914-20.
Epidemiology of overweight and obesity in a Greek adult population: the ATTICA
Study.
Panagiotakos DB, Pitsavos C, Chrysohoou C, Risvas G, Kontogianni MD, Zampelas A,
Stefanadis C.
Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
d.b.panagiotakos@usa.net
OBJECTIVE: To evaluate the status of overweight and obesity in a Greek random
sample. RESEARCH METHODS AND PROCEDURES: From 2001 to 2002, 1514 men (20 to 87
years old) and 1528 women (20 to 89 years old) were enrolled into the study.
Among several sociodemographic, lifestyle, and bioclinical factors,
anthropometric characteristics were also recorded. Overweight and obesity were
defined according to the World Health Organization classification. RESULTS: The
prevalences of overweight and obesity were 53% and 20% in men and 31% and 15% in
women (p for gender differences < 0.05). The age-adjusted peak prevalence of
obesity was observed in men older than 40 years old and women between 50 and 59
years old (Bonferonni alpha < 0.001). Central obesity prevailed in 36% of men and
43% of women (p for gender differences < 0.001). Obesity varied from 10% in rural
to 25% in urban areas, but this difference was explained mainly by differences in
occupational status (p = 0.9). Moreover, obese and overweight participants were
older, less educated, more frequently sedentary, consumed higher quantities of
alcoholic beverages, and were devoted to an unhealthier diet as compared with
those of normal weight (all p < 0.05). A positive association was also observed
between BMI and diastolic and systolic blood pressures, total cholesterol,
triglycerides, and glucose levels (all p < 0.001). DISCUSSION: Overweight and
obesity seem to be a great health problem in the Greek population, especially in
middle-aged and older adults. Unfavorable lifestyle habits, low education, and
the classical cardiovascular risk factors were associated with the prevalence of
these health conditions.
PMID: 15687390 [PubMed - indexed for MEDLINE]
61. Eur J Clin Nutr. 2005 Feb;59(2):185-95.
Socio-demographic inequalities in the diets of mid-aged Australian women.
Mishra G, Ball K, Patterson A, Brown W, Hodge A, Dobson A.
MRC Human Nutrition Research, Cambridge, UK. Gita.Mishra@mrc-hnr.cam.ac.uk
OBJECTIVES: This study reports on the distributions of food and nutrient intakes
by socio-demographic factors for a large population sample of mid-aged Australian
women participating in the Australian Longitudinal Study on Women's Health.
DESIGN: This cross-sectional population-based study used the Cancer Council of
Victoria food frequency questionnaires to derive estimates of food and nutrient
intakes. SETTING: Nationwide community-based survey. SUBJECTS: A total of 10561
women aged 50-55 y, at the time of the survey in 2001. RESULTS: Analysis showed
favourable patterns of food intake, with frequent consumption of many foods that
are promoted as components of a healthy diet (eg, fresh fruit, leafy green and
other vegetables, bread, cereals, milk and meat). Intakes of both foods and
nutrients varied significantly across socio-demographic groups, with unmarried
women, and women in 'labouring' occupations (eg, cleaner, factory worker,
kitchenhand) having poorer nutrient intake. CONCLUSIONS: Although many mid-aged
women in this sample had generally healthful diets, women in certain
socio-demographic groups (particularly unmarried women and those in labouring
occupations) had nutrient intakes of concern. As well as helping to address the
dearth of current data on dietary intakes in the Australian population, the
results highlight the need for continued targeted public health strategies aimed
at improving diet of women from the various socio-economic backgrounds.
PMID: 15483637 [PubMed - indexed for MEDLINE]
62. Int J Obes (Lond). 2005 Jan;29(1):54-9.
Influence of social class on time trends in BMI distribution in 5-year-old French
children from 1989 to 1999.
Romon M, Duhamel A, Collinet N, Weill J.
Department of Nutrition, University Hospital of Lille, Lille, France.
mromon@univ-lille2.fr
AIMS: To assess the prevalence of obesity and changes in body mass index (BMI)
distribution between 1989 and 1999 in 5-y-old children, and to study the
influence of parental socioeconomic status on these parameters. METHODS: Two
cohorts of children in the final year of nursery school (in the city of Lille,
France) were enrolled in 1989 (705 children: mean age=5.6+/-0.4 y) and 1999 (1258
children: mean age=5.6+/-0.5 y). Weight and height were measured, and data about
parental occupation were collected during a school medical examination.
International Obesity Task Force cutoff points were used to define overweight and
obesity. Parental occupation was classified into four categories. RESULTS: The
prevalence of obesity increased from 1.8 to 4.9%, and the prevalence of
overweight rose from 9.6 to 16.9%. Mean-difference plots allowed qualitative
comparisons of the BMI distribution between the surveys: for children from the
highest social classes, there was no change in BMI; for children from
intermediate classes, there was a up-shift only in the upper part of the
distribution with the heaviest children becoming heavier still; finally, for
children from the lowest class, there was an increase in BMI across the entire
population. CONCLUSIONS: This study of the changes in BMI distribution gives
greater insight into the 'obesity epidemic'. Our results show the influence of an
interaction between genetic and environmental factors. The increase in BMI in the
upper part of the distribution suggests that this is a population with a high
degree of susceptibility, whereas the increase in BMI across the whole population
in the lowest social class suggests a strong influence of the environment on this
group and thus the necessity of appropriate, preventive measures.
PMID: 15467778 [PubMed - indexed for MEDLINE]
63. J Nutr Health Aging. 2004;8(5):395-9.
Macronutrient intakes of elderly in the Lipid Research Clinics Program Prevalence
Study.
Anderson JJ, Suchindran CM, Kritchevsky SB, Barrett-Connor E.
Collaborative Studies Coordinating Center and Department of Nutrition, University
of North Carolina at Chapel Hill, NC 27599-7400, USA.
As part of the Lipid Research Clinics (LRC) Program Prevalence Study of coronary
heart disease risk factors, nutrient intakes of two US populations over 59 years
of age were determined by 24-hour recalls in the 1970s. Characteristics of the
populations were (1) California: suburban, upper-middle class, 95% high school
graduates, 10% blue collar occupations; (2) Oklahoma: rural lower-middle class,
75% high school graduates, and 40% blue-collar occupations. Macronutrients
consumed by both populations were similar, except for alcohol. For both men and
women, energy intake was approximately 25 kcal/kg/day (body weight) sources of
energy were approximately 40% from carbohydrate, 16% from protein, 37% from fat,
and 4% from alcohol. The Oklahoma population, however, consumed significantly
less alcohol than did Californians. Percentages of calories from fatty acids were
approximately 14% from saturated and 6% from polyunsaturated, which yielded a
polyunsaturated: saturated ratio of 0.48. The intake of cholesterol for women was
190 mg/1000 kcal and for men, 210 mg/1000 kcal. Between the ages of 60 and 69,
the Oklahoma men consumed more energy than did the California men. Both sexes
demonstrated lower energy intakes with advancing age and with increasing body
mass index. The higher energy intake of the Oklahoma cohort aged 60-69 was
attributed to the greater physical demands of their occupations, but this
difference disappeared after age 70. The California and Oklahoma women had
similar caloric intakes beyond age 60. In summary, the LRC findings suggest that
geographically diverse American populations consumed in the late 1970s remarkably
similar intakes of macronutients and cholesterol, with the only major exception
being energy from alcoholic beverages.
PMID: 15359359 [PubMed - indexed for MEDLINE]
64. Br J Nutr. 2004 Aug;92(2):321-33.
Changes over 20 years in macronutrient intake and body mass index in 11- to
12-year-old adolescents living in Northumberland.
Fletcher ES, Rugg-Gunn AJ, Matthews JN, Hackett A, Moynihan PJ, Mathers JC,
Adamson AJ.
Human Nutrition Research Centre, University of Newcastle upon Tyne, NE1 4LP, UK.
Monitoring adolescent diets over time enables the assessment of the effectiveness
of public health messages which are particularly important in vulnerable groups
such as adolescents. In 2000, 424 children aged 11-12 years old completed two 3 d
estimated dietary records. On the fourth day one nutritionist interviewed each
child to clarify the information in the diary and foods were quantified with the
aid of food models. Nutrient intake was calculated using computerised food
tables. These children attended the same seven schools in the same Northumberland
area as the 11- to 12-year-old children who recorded their diet using the same
method in 1980 (n 405) and 1990 (n 379), respectively. Height and weight, and
parental occupation were recorded in all three surveys for each child. Height and
weight were used to calculate BMI, weight was used to estimate BMR and parental
occupation was used to determine social class. Comparing the macronutrient
intakes in 2000 with 1980 and 1990, energy intakes (EI) fell in boys (to 8.45 MJ)
and girls (to 7.60 MJ). This fall may, at least in part, be due to an increase in
low energy reporting. For 1980, 1990 and 2000 the percentage of boys with EI:BMR
below 1.1 was 6, 15 and 23 %, respectively; for girls, 3, 14 and 18 %,
respectively. Percentage energy from fat was unchanged between 1980 and 1990 but
fell to 35 % (about 76 g/d) in 2000, alongside a 3 % increase in percentage
energy from starch (30 %). Percentage energy from non-milk extrinsic sugars
remained above recommendations (16 %; about 82 g/d). The number of overweight and
obese children increased from 11 % to 30 % between 1980 and 2000. Positive
changes have occurred in the Northumbrian adolescent diet but social
inequalities, reported in previous surveys, remain.
PMID: 15333164 [PubMed - indexed for MEDLINE]
65. Int Arch Occup Environ Health. 2004 Oct;77(7):491-8. Epub 2004 Aug 21.
Comparison of 1-hydroxypyrene exposure in the US population with that in
occupational exposure studies.
Huang W, Grainger J, Patterson DG Jr, Turner WE, Caudill SP, Needham LL, Pirkle
JL, Sampson EJ.
National Center for Environmental Health, Centers for Disease Control and
Prevention, 4770 Buford Highway NE , Mailstop F-47, Atlanta, GA 30341, USA.
Wfh7@cdc.gov
Urine samples collected in 1999 and 2000 as part of the National Health and
Nutrition Examination Survey (NHANES) were analyzed for 14 monohydroxy polycyclic
aromatic hydrocarbons (PAHs), and, for the first time, reference range values
were calculated for these metabolites in the US population. Pyrene is a major
component of most PAH mixtures and often is used as a surrogate for total PAH
exposure. We detected 1-hydroxypyrene (1-OHpyrene), a metabolite of pyrene, in
more than 99% of the samples. The overall geometric mean concentration for
1-OHpyrene in the USA was 79.8 ng/l, with a 95% confidence interval (CI) of
69.0-92.2 ng/l. The overall geometric mean creatinine-adjusted urinary 1-OHpyrene
levels in the USA was 74.2 ng/g creatinine (0.039 micromol/mol), with a 95% CI of
64.1-85.9 ng/g creatinine (0.034-0.046 micromol/mol). There were no statistically
significant differences among age, gender, or race/ethnicity groups. Adult
smokers in the USA have urinary 1-OHpyrene levels three times higher than those
of non-smokers. This difference was statistically significant. In this paper, we
compare the reference range of urinary 1-OHpyrene levels with levels reported
from various occupations by other researchers.
PMID: 15322857 [PubMed - indexed for MEDLINE]
66. Am J Ind Med. 2004 Aug;46(2):126-35.
Airflow obstruction attributable to work in industry and occupation among U.S.
race/ethnic groups: a study of NHANES III data.
Hnizdo E, Sullivan PA, Bang KM, Wagner G.
Division of Respiratory Disease Studies, National Institute for Occupational
Safety and Health, Centers for Disease Control and Prevention, Morgantown, West
Virginia 26505, USA. exh6@cdc.gov
OBJECTIVES: To estimate the fraction of airflow obstruction attributable to
workplace exposure by U.S. race/ethnic group. METHODS: U.S. population-based
third National Health and Nutrition Examination Survey (NHANES III) data on 4,086
Caucasians, 2,774 African-Americans, and 2,568 Mexican-Americans, aged 30-75,
were studied. Airflow obstruction was defined as FEV1/FVC<75% and FEV1<80%
predicted. Weighted prevalence, and prevalence odds ratios (OR) adjusted for the
effect of age, smoking status, pack-years, body mass index, education, and
socio-economic status were estimated using SUDAAN software. RESULTS: Industries
with the most cases of airflow obstruction attributable to workplace exposure
include: armed forces; rubber, plastics, and leather manufacturing; utilities;
textile mill manufacturing; health care; food products manufacturing; sales;
construction; and agriculture. The fraction of cases with airflow obstruction
associated with work in industry varied by race/ethnic group and was estimated as
22.2% (95% CI 9.1-33.4) among Caucasians, 23.4% (95% CI 2.2-40.0) among
African-Americans, and 49.6% (32.1-62.6) among Mexican-Americans. CONCLUSIONS:
This study found differences in the fraction of airflow obstruction cases
associated with employment pattern among major U.S. race/ethnic population
groups.
PMID: 15273964 [PubMed - indexed for MEDLINE]
67. J Occup Environ Med. 2004 Jul;46(7):720-8.
Blood lead levels in U.S. workers, 1988-1994.
Yassin AS, Martonik JF, Davidson JL.
Office of Evaluations and Audit Analysis, Occupational Safety and Health
Administration, United States Department of Labor, Washington, DC, USA.
yassin.abdiaziz@dol.gov
Limited research has been conducted to measure the association between elevated
blood lead levels and sociodemographic factors among U.S. workers in various
industries and occupations using population-based survey data. Data from the
Third National Health and Nutrition Examination Survey ( n = 10,127) were used to
determine the blood lead levels in the U.S. workers. The prevalence of elevated
blood lead levels > or = 50 microg/dL was 0.001% (1560) among U.S. workers
compared with 0.2% (19,953) workers with elevated lead levels > or = 40
microg/dL. Regression analyses indicated that workers in the repair service
industry were correlated with higher blood lead levels than those workers in the
construction industry. Although low blood lead levels were found for the entire
working population, the results showed that there were still high blood lead
levels in certain occupations and industries during 1988 to 1994.
PMID: 15247812 [PubMed - indexed for MEDLINE]
68. J Occup Environ Hyg. 2004 May;1(5):324-33.
Urinary cadmium levels in the U S working population, 1988-1994.
Yassin AS, Martonik JF.
Occupational Safety and Health Administration (OSHA), United States Department of
Labor, Washington, D C 20210, USA. yassin.abdiaziz@dol.gov
Few studies have estimated the prevalence and mean urinary cadmium levels in U.S.
workers and the factors associated with high cadmium exposure. In this study,
urinary cadmium measurements were obtained on 11228 U.S. workers aged 18 to 64
years who participated in the Third National Health and Nutrition Examination
Survey (NHANES III, 1988-1994). Urinary cadmium levels ranged from 0.01 to 15.57
microg/L, with a geometric mean of 0.30 microg/L (0.28 microg/g creatinine) for
all U.S. workers. The prevalence of urinary cadmium levels >or=5 microg/L was
0.42% (551000) for U.S. workers aged 18 to 64 years. Among U.S. workers in the
metal industry (two-digit Standard Industrial Classification or SIC codes 33 and
34), the geometric mean urinary cadmium level was 0.48 microg/L (0.39 microg/g
creatinine), and 0.45% of these workers had urinary cadmium levels >or=10
microg/L. The prevalence of urinary cadmium levels >or=15 microg/L was 0.0028%
(3907). The agriculture industry (two-digit SIC codes 01, 02, and 07-09) was
associated with low urinary cadmium levels, compared with repair services
industries (two-digit SIC codes 75 and 76). Results from ordinary least squares
regression analyses indicated that smokers had significantly higher urinary
cadmium levels than nonsmokers (p or= 25) and obesity (BMI > or = 30) increase from 20 to 29 years
and peak at 40-49 years in men and at 50-59 years in women before starting to
decline. One woman in two is overweight and one woman in five is obese, whereas
one-third of men are overweight and only 5% are obese. Obese subjects have a
larger age-adjusted waist to hip ratio(WHR) than their non-overweight
counterparts, attesting that fat gain is oriented towards a more abdominal fat
mass distribution. The length of residence in Yaounde, increasing education
level, occupation, ethnicity, physical inactivity and smoking practices appear to
influence early overweight and/or obesity. No parity effect is observed in women.
From the present study, it appears that obesity, and especially obesity in women,
could be less benign than that described in other studies in Africa. CONCLUSION:
Research is needed in Cameroon, including aetiological and cohort studies aimed
at the quantification of morbidity and mortality risks associated with overweight
and obesity.
PMID: 12959896 [PubMed - indexed for MEDLINE]
77. Afr J Med Med Sci. 1999 Mar-Jun;28(1-2):9-12.
Biochemical indicators of metabolic poisoning associated with lead based
occupations in nutritionally disadvantaged communities.
Anetor JI, Adeniyi FA, Taylor GO.
Department of Chemical Pathology, College of Medicine, University of Ibadan,
Ibadan, Nigeria.
The biochemical alterations that occur in chronic lead exposure were studied in
86 males who were occupationally exposed to the metal. The biochemical indices
investigated were blood lead, total and ionized calcium, inorganic phosphate,
total protein and albumin, uric acid and 1,25 dihydroxycholecalciferol [1,25]
(OH2 D3]. Serum total and ionized calcium levels and 1,25 [OH2] D3 were
significantly lower in lead workers than in the control population (P < 0.01 and
P < 0.001, respectively). Multiple regression analysis showed an important
relationship between blood lead and serum calcium. Uric acid which was positively
correlated with blood lead levels was significantly higher in lead workers than
in controls P < 0.001. There were no changes in the other biochemical indices
studied. The biochemical abnormalities that were established in this report which
actually reflect metabolic poisoning may be helpful in the early detection of
plumbism before the onset of clinical lead poisoning, particularly in
nutritionally disadvantaged communities.
PMID: 12953979 [PubMed - indexed for MEDLINE]
78. Public Health Nutr. 2003 Aug;6(5):479-84.
Consumption of whole-grain foods by British adults: findings from further
analysis of two national dietary surveys.
Lang R, Thane CW, Bolton-Smith C, Jebb SA.
MRC Human Nutrition Research, Elsie Widdowson Laboratory, Fulbourn Road, CB1 9NL,
UK. beckie.lang@mrc-hnr.cam.ac.uk
OBJECTIVE: To assess the consumption of whole-grain foods in different age and
sociodemographic groups in Great Britain, using data from two national surveys.
DESIGN: Cross-sectional analysis of the consumption of whole-grain foods.
SETTING: The 1986-87 Dietary and Nutritional Survey of British Adults and the
1994-95 National Diet and Nutrition Survey of people aged 65 years and over.
SUBJECTS: In 1986-87, 2086 British adults aged 16-64 years; 1189 British adults
aged 65 years and over in 1994-95. RESULTS: In the 1986-87 survey population,
consumption of whole-grain foods increased with age. Median consumption of
whole-grain foods was 1 serving per week in 16-24-year-olds and 3 servings per
week in the 35-64-year-olds In 1994-95, median consumption was 5 servings per
week in adults aged 65 years and over. Overall, one-third of British adults ate
no whole-grain foods on a daily basis, and less than 5% ate 3 or more servings
per day. Manual occupation and smoking were consistently associated with a higher
proportion of non-consumers and fewer servings per week of whole-grain foods,
independent of age, sex, region and season (each ). The main sources of
whole-grain foods were wholemeal bread and breakfast cereals, which accounted for
more than three-quarters of all servings. CONCLUSIONS: Consumption of whole-grain
foods in the adult UK populations is more prevalent in the non-smoking, higher
socio-economic groups. Amongst consumers of whole-grain foods, the frequency is
similar to that reported in the USA and Norway.
PMID: 12943564 [PubMed - indexed for MEDLINE]
79. Eur J Clin Nutr. 2003 Aug;57(8):917-29.
A systematic review of socioeconomic differences in food habits in Europe:
consumption of cheese and milk.
Sanchez-Villegas A, Martínez JA, Prättälä R, Toledo E, Roos G, Martínez-González
MA; FAIR-97-3096 Group.
Department of Epidemiology and Public Health, University of Navarra, Pamplona,
Spain.
OBJECTIVE: To assess differences in cheese and milk consumption across
socioeconomic groups in representative samples from several European countries.
DESIGN: A meta-analysis of published and unpublished surveys of food habits
performed in nine European countries between 1985 and 1999. Educational and
occupational levels were used as indicators of socio-economic status. RESULTS: A
higher socioeconomic status was associated with a greater consumption of cheese.
The pooled estimate of the difference in cheese consumption between women in the
highest vs the lowest educational level was 9.0 g/day (95% CI: 7.1 to 11.0). The
parallel observation in men was 6.8 g/day (95% CI: 3.4 to 10.1). Similar results
were obtained using occupation as an indicator of socioeconomic status. The
pooled estimates of the higher cheese consumption among subjects belonging to the
highest (vs the lowest) occupational level were 5.1 g/day (95% CI: 3.7 to 6.5) in
women and 4.6 g/day (95% CI: 2.1 to 7.0) in men. No statistically significant
associations were found for milk consumption concerning educational or
occupational level. CONCLUSIONS: Our findings suggest that consumption of cheese
is likely to be higher among subjects belonging to higher socioeconomic levels.
We did not find enough evidence to support that milk intake is different
according to educational or social levels.
PMID: 12879086 [PubMed - indexed for MEDLINE]
80. J Epidemiol. 2003 Jan;13(1 Suppl):S134-47.
Validity and reproducibility of a self-administered food frequency questionnaire
in the JPHC Study Cohort II: study design, participant profile and results in
comparison with Cohort I.
Ishihara J, Sobue T, Yamamoto S, Yoshimi I, Sasaki S, Kobayashi M, Takahashi T,
Iitoi Y, Akabane M, Tsugane S; JPHC.
Cancer Information and Epidemiology Division, National Cancer Center Research
Institute.
The objective of this study was to evaluate the validity and reproducibility of a
self-administered food frequency questionnaire (FFQ) to estimate nutrient and
food intake in the subjects of the Japan Public Health Center-based prospective
Study on Cancer and Cardiovascular Diseases (JPHC Study Cohort II). The FFQ was
originally developed to estimate intake in the JPHC Study Cohort I. A total of
392 subjects were recruited from the entire cohort participants in the 6 areas of
Cohort II on a voluntary basis. The subjects completed the FFQ used for the
5-year follow-up survey twice at approximately a 1-year interval. Seven-day
dietary records (DR) and blood samples were collected 4 times at 3-month
intervals over a year. Daily nutrient and food intakes from FFQ and DR were
estimated. The Spearman correlation coefficients for estimated intakes were
calculated between FFQ and DR for validity, and between 2 identical FFQs for
reproducibility. Correlation coefficients for the validity ranged from 0.09 to
0.82 among various nutrients and food groups. The correlation coefficients for
most of the nutrients and food groups were improved to a level comparable to that
of Cohort I by energy-adjustment. Correlation coefficients for reproducibility
ranged from 0.42 to 0.82, similar to those of Cohort I.
PMID: 12701641 [PubMed - indexed for MEDLINE]
81. Public Health Nutr. 2003 Apr;6(2):191-200.
Measuring socio-economic position in dietary research: is choice of
socio-economic indicator important?
Turrell G, Hewitt B, Patterson C, Oldenburg B.
Queensland University of Technology, School of Public Health, Victoria Park Road,
Kelvin Grove, Brisbane, 4059. g.turrell@qut.edu.au
OBJECTIVES: To examine the association between socio-economic position (SEP) and
diet, by assessing the unadjusted and simultaneously adjusted (independent)
contributions of education, occupation and household income to food purchasing
behaviour. DESIGN: The sample was randomly selected using a stratified two-stage
cluster design, and the response rate was 66.4%. Data were collected by
face-to-face interview. Food purchasing was examined on the basis of three
composite indices that reflected a household's choice of grocery items (including
meat and chicken), fruit and vegetables. SETTING: Brisbane City, Australia, 2000.
PARTICIPANTS:: Non-institutionalised residents of private dwellings located in 50
small areas (Census Collectors Districts). RESULTS: When shopping, respondents in
lower socio-economic groups were less likely to purchase grocery foods that were
high in fibre and low in fat, salt and sugar. Disadvantaged groups purchased
fewer types of fresh fruits and vegetables, and less often, than their
counterparts from more advantaged backgrounds. When the relationship between SEP
and food purchasing was examined using each indicator separately, education and
household income made an unadjusted contribution to purchasing behaviour for all
three food indices; however, occupation was significantly related only with the
purchase of grocery foods. When education and occupation were simultaneously
adjusted for each other, the socio-economic patterning with food purchase
remained largely unchanged, although the strength of the associations was
attenuated. When household income was introduced into the analysis, the
association between education, occupation and food purchasing behaviour was
diminished or became non-significant; income, however, showed a strong, graded
association with food choice. CONCLUSIONS: The food purchasing behaviours of
socio-economically disadvantaged groups were least in accord with dietary
guideline recommendations, and hence are more consistent with greater risk for
the development of diet-related disease. The use of separate indicators for
education, occupation and household income each adds something unique to our
understanding of how socio-economic position is related to diet: each indicator
reflects a different underlying social process and hence they are not
interchangeable, and do not serve as adequate proxies for one another.
PMID: 12675962 [PubMed - indexed for MEDLINE]
82. Public Health Nutr. 2003 Apr;6(2):139-46.
Physical activity, diet and cardiovascular disease risks in Chinese women.
Ma J, Liu Z, Ling W.
Department of Clinical Nutrition, School of Public Health, Zhon Shan University
(North Campus), 74 Zhongshan Road II, Guangzhou, 510080, People's Republic of
China.
OBJECTIVE: To investigate the relationship between different types and levels of
physical activity and cardiovascular disease risk factors, including oxidative
stress, blood lipids and insulin resistance, in a healthy female population in
China. METHOD: Healthy women aged 35 to 65 years participated in this study. The
habitual physical activity was evaluated by self-administered questionnaire
(MOSPA). The dietary intakes of nutrients were calculated from 3-day recall
records. Anthropometric data of each subject were measured, fasting blood samples
were taken, and erythrocytes and serum were prepared for the measurement of
erythrocyte superoxide dismutase activity, serum malondialdehyde, total
antioxidant capacity, insulin, glucose and lipids (total cholesterol,
triglycerides, apolipoprotein AI (apo A) and apolipoprotein B (apo B))
concentrations. RESULTS: Low level of physical activity was related to a lower
concentration of serum apo B, and higher energy expenditure from household
physical activity had a reverse relationship with serum apo B and triglyceride
levels. In the group with moderate occupational energy expenditure, the
concentration of serum triglycerides was lower, but that of high-density
lipoprotein was higher. Moderate energy expenditure (less than 1700 kcal day-1)
from leisure-time physical activity was positively related to total antioxidant
capacity and insulin sensitivity. However, heavy occupational physical activity
may be not beneficial for the cardiovascular system. CONCLUSION: This study
indicates that leisure-time, moderate occupational and household physical
activity levels decreased risk factors for cardiovascular disease.
PMID: 12675956 [PubMed - indexed for MEDLINE]
83. East Afr Med J. 2002 Oct;79(10):524-9.
Child care practices and nutritional status of children aged 0-2 years in Thika,
Kenya.
Kamau-Thuita F, Omwega AM, Muita JW.
Department of Community Health, College of Health Sciences, University of
Nairobi, P.O. Box 19676, Nairobi, Kenya.
OBJECTIVE: To assess time allocation for child care and the nutritional status of
children aged 0-2 years. DESIGN: Cross sectional descriptive survey using a
structured questionnaire and taking of anthropometric measurements to determine
the nutritional status of children aged 0 to 2 years. In addition, two day (10
hour) observations were conducted in a subsample of households to assess time
allocation for the main child care activities. SETTING: A low-income peri-urban
section of Thika town (in Makongeni estate), Kenya. Subjects: A random sample of
150 mothers and their 0-2 year old children. RESULTS: Mother's knowledge about
child care influences the amount and type of care that is given to children. Time
taken to perform various activities was also found to vary with the mother's
education level, her occupation, number of children less than five years in the
house and the child's age and birth order. Comparatively, children who were
malnourished (stunted) had less time devoted to them for breastfeeding, food
preparation and feeding. Although mothers were the primary caregivers, the
responsibility of care giving was shared with other household members as well as
with neighbours. CONCLUSION: The amount and type of care that a child receives is
determined to a large extent by the mother and caregivers knowledge.
PMID: 12635757 [PubMed - indexed for MEDLINE]
84. Public Health Nutr. 2002 Dec;5(6):719-26.
Urbanisation and cariogenic food habits among 4-24-month-old black South African
children in rural and urban areas.
MacKeown JM, Faber M.
Dental Research Institute, University of the Witwatersrand, Private Bag X03,
Johannesburg, South Africa. mackeownj@dentistry.wits.ac.za
OBJECTIVE: To determine if social class, education level and group environment
(rural and urban) influence particular food habits commonly associated with
dental caries incidence among 4-24-month-old black South African children.
DESIGN, SETTING AND SUBJECTS: Information was collected by trained interviewers
using a food-frequency questionnaire from mothers of children in two areas in
South Africa: Ndunakazi, a rural area in KwaZulu/Natal (n = 105) and two urban
areas in Gauteng - Soweto (low to middle socio-economic area) (n = 100) and the
northern suburbs of Johannesburg and Sandton (middle to upper socio-economic
area) (n = 101). Education level and occupation of the parents, which define
social class, were also recorded. A linear logistic (Proc Catmod) analysis tested
social class, education level and group environment as the independent variables
and the food habits as the dependent variables. RESULTS: Group environment was
significantly associated with nine of the 18 food habits investigated. More urban
than rural mothers added sugar to their child's comforter. More mothers in urban
Soweto than in urban Johannesburg were still breast-feeding their infants at 24
months. More rural than urban mothers were giving 'mutis' (common and traditional
medicines). Together with group environment, education level was significantly
associated with giving of 'mutis' and the frequency of giving them. Social class
was significantly associated with the frequency of breast-feeding and when the
child was breast-fed. Mothers from the upper social class breast-fed less
frequently than mothers from the lower class. CONCLUSION: The study showed a
strong influence of rural/urban environment on specific cariogenic food habits
among young black South African children, enabling the development and
implementation of a nutrition strategy.
PMID: 12570880 [PubMed - indexed for MEDLINE]
85. Eur J Clin Nutr. 2003 Jan;57(1):128-37.
Socio-economic status, dietary intake and 10 y trends: the Dutch National Food
Consumption Survey.
Hulshof KF, Brussaard JH, Kruizinga AG, Telman J, Löwik MR.
TNO Nutrition and Food Research Institute, Zeist, The Netherlands.
hulshof@voeding.tno.nl
OBJECTIVE: To study differences in dietary intake between adults with different
socioeconomic status (SES) and trends over time. DESIGN: Cross-sectional study
based on data of three Dutch National Food Consumption Surveys (DNFCS-1 1987/88;
DNFCS-2 1992; DNFCS-3 1997/98), obtained from a panel by a stratified probability
sample of the non-institutionalized Dutch population. SUBJECTS: A total of 6008
men and 6957 women aged 19 y and over. METHODS: Dietary intake was assessed with
a 2 day dietary record. Background information was obtained by structured
questionnaire. Sociodemographic variables were available from panel information.
SES, based on educational level, occupation and occupational position was
categorized into (very) low, middle and high. Analysis of variance with age as
covariable was used to explore the effects of SES on dietary intake and
anthropometry. Statistical tests for trend were carried out with models in which
week-weekend-day effects and an interaction term of time with SES were also
included. RESULTS: The prevalence of obesity and skipping of breakfast was higher
among people with a low SES. In all three surveys, subjects in the (very) low SES
group reported having a higher consumption of potatoes, meat and meat products,
visible fats, coffee and soft drinks (men only). Subjects with a high SES
reported consuming more vegetables, cheese and alcohol. As regards nutrients, in
all surveys a higher SES was associated with higher intake of vegetable protein,
dietary fibre and most micronutrients. A higher SES was also associated with a
lower fat intake but the differences between social classes were rather small and
not consistent when the contribution of alcohol to energy intake was taken into
account. CONCLUSION: In general, dietary intake among subjects in higher SES
groups tended to be closer to the recommendations of the Netherlands Food and
Nutrition Council and this phenomenon was quite stable over a period of 10 y.
PMID: 12548307 [PubMed - indexed for MEDLINE]
86. IARC Sci Publ. 2002;156:119-21.
How vegetables are eaten in Italy EPIC centres: still setting a good example?
Pala V, Berrino F, Vineis P, Palli D, Celentano E, Tumino R, Krogh V.
Epidemiology Unit, National Cancer Institute, Milan, Italy.
PMID: 12484142 [PubMed - indexed for MEDLINE]
87. Eur J Clin Nutr. 2002 Nov;56(11):1119-25.
Diet and nutritional status of rural adolescents in India.
Venkaiah K, Damayanti K, Nayak MU, Vijayaraghavan K.
National Institute of Nutrition, Indian Council of Medical Research, Hyderabad -
500 007, India. kodalivenkaiah@yahoo.com
OBJECTIVE: To study the current diet and nutritional status of rural adolescents
in India. DESIGN: Cross-sectional study with household as the unit of
randomization. SETTING: National Nutrition Monitoring Bureau collected
information in the rural areas of the nine States. METHODS: In each State, 120
villages were selected from eight districts. From each of the selected villages,
20 households (HHs) were selected from five clusters. The information on
socio-demographic profile was collected in all the 20 HHs, while anthropometric
data such as weight, height and clinical signs of nutritional deficiency was
collected on all the available adolescents in the selected households. In every
fourth sampled household, ie five HHs, dietary information on all the members was
collected using 24 h dietary recall. The outcome measures for nutritional status
were proportion of underweight (or= 30 kg/m(2)). Three major dietary patterns were
identified: mixed pattern when all food groups and items had about the same
factor loading, except for rice and beans; one pattern that relies mainly on rice
and beans, which was called a traditional diet; and a third pattern, termed a
Western diet, where fat (butter and margarine) and added sugar (sodas) showed the
highest positive loading and rice and beans were strong negative components.
Among men, the Western diet also included deep-fried snacks and milk products
with high positive values. The traditional diet was associated with lower risk of
overweight/obesity in logistic models adjusted for dieting, age, leisure physical
activity, and occupation (13% reduction in men and 14% reduction in women
comparing the traditional and Western diets). DISCUSSION: Factors contributing to
the effects of the Brazilian traditional diet may include low-energy density,
high-dietary fiber content, incorporation of low glycemic index foods such as
beans, or a relatively low food variety.
PMID: 11786600 [PubMed - indexed for MEDLINE]
97. Asia Pac J Clin Nutr. 2001;10(1):39-45.
Can dietary factors explain differences in serum cholesterol profiles among
different ethnic groups (Chinese, Malays and Indians) in Singapore?
Deurenberg-Yap M, Li T, Tan WL, van Staveren WA, Chew SK, Deurenberg P.
Department of Nutrition, Ministry of Health, Singapore. mabel_yap@moh.gov.sg
In Singapore. there exists differences in risk factors for coronary heart disease
among the three main ethnic groups: Chinese, Malays and Indians. This study aimed
to investigate if differences in dietary intakes of fat, types of fat,
cholesterol, fruits, vegetables and grain foods could explain the differences in
serum cholesterol levels between the ethnic groups. A total of 2408 adult
subjects (61.0% Chinese, 21.4% Malays and 17.6% Indians) were selected
systematically from the subjects who took part in the National Health Survey in
1998. The design of the study was based on a cross-sectional study. A food
frequency questionnaire was used to assess intakes of energy, total fat,
saturated fat, polyunsaturated fat, monounsaturated fat, cholesterol, fruits,
vegetables and cereal-based foods. The Hegsted score was calculated. Serum total
cholesterol, low density lipoprotein cholesterol, high density lipoprotein
cholesterol were analysed and the ratio of total cholesterol to high density
lipoprotein cholesterol was computed. The results showed that on a group level
(six sex-ethnic groups), Hegsted score, dietary intakes of fat, satutrated fat,
cholesterol, vegetables and grain foods were found to be correlated to serum
cholesterol levels. However, selected dietary factors did not explain the
differences in serum cholesterol levels between ethnic groups when multivariate
regression analysis was performed, with adjustment for age, body mass index,
waist-hip ratio, cigarette smoking, occupation, education level and physical
activity level. This cross-sectional study shows that while selected dietary
factors are correlated to serum cholesterol at a group level, they do not explain
the differences in serum cholesterol levels between ethnic groups independently
of age, obesity, occupation, educational level and other lifestyle risk factors.
PMID: 11708607 [PubMed - indexed for MEDLINE]
98. Am J Ind Med. 2001 Sep;40(3):233-9.
Prevalence of cigarette smoking by occupation and industry in the United States.
Bang KM, Kim JH.
Division of Respiratory Disease Studies, National Institute for Occupational
Safety and Health, CDC, Morgantown, West Virginia 26505, USA. kmb2@cdc.org
BACKGROUND: This study was undertaken to estimate the most recent prevalence of
cigarette smoking by occupation and industry in the US, using the data from the
third National Health and Nutrition Examination Survey (NHANES III), 1988-1994.
METHODS: Included in NHANES III are data on the cigarette smoking status,
occupation, industry, and other demographic information of US
non-institutionalized civilians obtained through household interview surveys. The
study population included 20,032 adults aged 17 years and older. To estimate the
prevalence of cigarette smoking across occupation and industry groups, we used
the Survey Data Analysis (SUDAAN) software. RESULTS: The prevalence of cigarette
smoking was highest among material moving occupations, construction laborers, and
vehicle mechanics and repairers. The lowest smoking prevalence was found among
teachers. Among industry groups, the construction industry had the highest
prevalence of cigarette smoking. CONCLUSIONS: These findings provide information
useful for targeting education activities focusing on adverse health effects of
cigarette smoking and also for indirect adjustments in analysis of morbidity and
mortality by occupation. Am. J. Ind. Med. 40:233-239, 2001. Published 2001
Wiley-Liss, Inc.
PMID: 11598969 [PubMed - indexed for MEDLINE]
99. Am J Epidemiol. 2001 Aug 15;154(4):357-65.
Toxoplasma gondii infection in the United States: seroprevalence and risk
factors.
Jones JL, Kruszon-Moran D, Wilson M, McQuillan G, Navin T, McAuley JB.
Division of Parasitic Diseases, National Center for Infectious Diseases, Centers
for Disease Control and Prevention, Atlanta, GA 30341-3724, USA. jlj1@cdc.gov
Infection with Toxoplasma gondii can cause severe illness when the organism is
contracted congenitally or when it is reactivated in immune-suppressed persons.
To determine the prevalence of T. gondii infection in a representative sample of
the US population, the authors tested sera from participants in the Third
National Health and Nutrition Examination Survey (1988-1994) for immunoglobulin G
antibodies to T. gondii. Of 27,145 persons aged > or =12 years, 17,658 (65%) had
sera tested. The overall age-adjusted seroprevalence was 22.5% (95% confidence
interval (CI): 21.1, 23.9); among women aged 15-44 years, seroprevalence was
15.0% (95% CI: 13.2, 17.0). Age-adjusted seroprevalence was higher in the
Northeast (29.2%) than in the South (22.8%), Midwest (20.5%), or West (17.5%) (p
< 0.05). In multivariate analysis, risk for T. gondii infection increased with
age and was higher among persons who were foreign-born, persons with a lower
educational level, those who lived in crowded conditions, and those who worked in
soil-related occupations, although in subset analyses risk categories varied by
race/ethnicity. Nearly one quarter of adults and adolescents in the United States
have been infected with T. gondii. Most women of childbearing age in the United
States are susceptible to acute infection and should be educated about ways to
minimize exposure to T. gondii.
PMID: 11495859 [PubMed - indexed for MEDLINE]
100. P N G Med J. 1999 Sep-Dec;42(3-4):94-113.
Patterns of child growth in Papua New Guinea and their relation to environmental,
dietary and socioeconomic factors--further analyses of the 1982-1983 Papua New
Guinea National Nutrition Survey.
Mueller I, Smith TA.
Swiss Tropical Institute, Basel.
Child growth and nutrition in rural Papua New Guinea vary widely among different
environments. The 1982-1983 National Nutrition Survey (NNS) was re-analyzed in
order to relate patterns of growth to a wide range of dietary, socioeconomic,
agricultural and demographic variables. Anthropometric indices of growth were
calculated based on an internal Papua New Guinean growth standard constructed
from the children included in the NNS. Children were subsequently classified as
stunted, wasted or underweight if they were more than 1 SD below the national
mean. Regression analyses on 15,975 children show that variation in growth among
environments can largely be accounted for by differences in diet, although
significant differences in relation to altitude, relief and rainfall patterns
persist. Other important predictors of child growth and nutrition included
socioeconomic status, maternal education, marital status of the mother and
father's occupation. Variance components analysis revealed that most of the
geographical variation in child growth was accounted for by the environmental,
dietary, socioeconomic, agricultural and demographic variables included in the
regression analyses. Most of the factors which were found to be associated with
child growth in this study are related in one form or another to differences in
local subsistence agriculture, which may therefore be the main determinant of
child growth and nutrition patterns in Papua New Guinea.
PMID: 11428503 [PubMed - indexed for MEDLINE]
101. Ann Agric Environ Med. 2001;8(1):57-62.
Is there a territorial differentiation in the prevalence of peptic ulcer among
rural population in Poland?
Schabowski J.
Clinic for Internal and Occupational Diseases, Institute of Agricultural
Medicine, Jaczewskiego 2, P.O. Box 185, 20-950 Lublin, Poland.
schabow@galen.imw.lublin.pl
The aim of this study was to determine the prevalence of peptic ulcer among rural
population in various regions of Poland and to analyse the conditions influencing
the prevalence of the disease. For organizational reasons, the division of the
territory of Poland into eight regions was adopted for the study. The study
covered a representative group of 6,512 rural inhabitants, comprising 3,107 males
(47.7%) and 3405 women (52.3%), aged 20-64, selected by two-stage stratified
sampling. At the first stage of the study all health centres (3,286) were
classified into 150 groups and in each group two prevention-treatment regions
were selected by means of stratified sampling. The second-stage samples were
selected based on communes where the health centres classified for the study were
located. People selected for the study were subject to examinations which
covered: a specially designed questionnaire form, detailed physical examination,
and the necessary specialist tests. The obtained results were recorded in a
questionnaire form, which additionally contained questions concerning detailed
demographic and social data, hazardous factors present in the working
environment, as well as data pertaining to housing conditions, nutrition and
habits. Among the rural population under study, peptic ulcer was found in 8.0% of
males and 2.9% of females, gastric ulcer was observed in 1.2% of people under
study, duodenal ulcer - in 3.2%, gastric and duodenal ulcer - in 0.2%, whereas
patients who underwent surgical procedures due to peptic ulcer constituted 0.7%
of respondents. Territorial differences were noted in the prevalence of peptic
ulcer among Polish rural population. The highest peptic ulcer incidence rates
were observed in Macroregion I (western Poland) - where the disease was diagnosed
in 7.2% of people under study (Northern Region - 8.1%, Southern Region - 7.4%,
and South-Western Region - 6.4%), while the lowest rates were noted in
Macroregion II (central and eastern Poland), where peptic ulcer occurred among
4.7% of respondents (South-Eastern Region - 4.4%, North-Eastern Region - 4.5%,
Middle-Eastern Region - 4.7%, Middle- Western Region - 4.8%, and Central Region -
5.1%). In regions where the highest incidence rates were noted, the greatest
numbers of divorcees, widows and widowers were observed. An analysis by
occupational groups showed that in these regions there were more unskilled and
skilled workers, employees of services, and the largest number of people
performed non-agricultural occupations. Cigarette smoking habit was also more
prevalent in these regions.
PMID: 11426926 [PubMed - indexed for MEDLINE]
102. Eur J Clin Nutr. 2001 Jun;55(6):430-5.
Influence of sociodemographic factors in the prevalence of obesity in Spain. The
SEEDO'97 Study.
Aranceta J, Perez-Rodrigo C, Serra-Majem L, Ribas L, Quiles-Izquierdo J, Vioque
J, Foz M; Spanish Collaborative Group for the Study of Obesity.
Community Nutrition Unit, Department of Public Health, Municipality of Bilbao,
Bilbao, Spain. bisaludpublica@jet.es
OBJECTIVE: To analyse the influence of social and cultural factors in the
prevalence of obesity in the Spanish adult population aged 25--60 y based on
available population data. DESIGN: Pooled analysis of four cross-sectional
nutrition surveys. SUBJECTS: A total of 5388 free-living subjects aged 25--60 y,
respondents of the Nutritional Surveys carried out in four Spanish regions
(Catalunya, Basque Country, Madrid and Valencia) from 1990 to 1994. The samples
were pooled together and weighted to build a national random sample.
MEASUREMENTS: Weight and height were measured on each individual by trained
observers. Age, gender, educational level, occupation, habitat (rural/urban) and
region were considered. Obesity was defined as body mass index > or = 30 kg/m(2).
The protocol used in each survey was in accordance with the recommendations of
the Spanish Society for the Study of Obesity (SEEDO). Logistic regression models
were designed to analyse the influence of sociodemographic factors in the
prevalence of obesity in men and women. RESULTS: The prevalence of obesity was
higher in older age groups in men and women, odds ratio (OR) for every 10 y
OR=1.40 (95% CI 1.39--1.41) for men and OR=1.86 (95% CI 1.85--1.87) for women.
Logistic regression analysis adjusted for age showed higher obesity rates among
low educated people, OR=1.80 (95% CI 1.78--1.81) in men and OR=2.36 (95% CI
2.29--2.42) in women (P<0.001). Among men the odds ratio for the prevalence of
obesity in rural areas was OR=1.87 (95% CI 1.86--1.89), compared to cities. The
geographical distribution showed higher obesity rates in the southeast.
CONCLUSION: This study supports that obesity is a multifactorial problem. Older
women with low educational level and low income seem to be the most susceptible
group to weight gain. Therefore, Public Health Programs should consider this type
of environmental factor when planning strategies aimed at preventing or reducing
the problem of obesity in western societies.
PMID: 11423919 [PubMed - indexed for MEDLINE]
103. Int J Epidemiol. 2001 Apr;30(2):334-40.
Diet and socioeconomic position: does the use of different indicators matter?
Galobardes B, Morabia A, Bernstein MS.
Division of Clinical Epidemiology, University Hospital of Geneva, Switzerland.
bruna.galobardes@hcuge.ch
OBJECTIVES: To describe the association of diet and socioeconomic position and to
assess whether two different indicators, education and occupation, independently
contribute in determining diet. METHODS: A community-based random sample of men
and women residents of Geneva canton, aged 35 to 74, participated in a survey of
cardiovascular risk factors conducted annually since 1993. Lifetime occupational
and educational history and a semi-quantitative food frequency questionnaire were
obtained from 2929 men and 2767 women. RESULTS: Subjects from lower education
and/or occupation consumed less fish and vegetables but more fried foods, pasta
and potatoes, table sugar and beer. Iron, calcium, vitamin A and vitamin D intake
were lower in the lower educational and occupational groups. Both indicators
significantly contributed to determining a less healthy dietary pattern for those
from low social class. The effects of education and occupation on dietary habits
were usually additive and synergistic for some food groups. CONCLUSION: Assessing
both education and occupation, improves the description of social class
inequalities in dietary habits, as they act, most of the time, as independent
factors.
PMID: 11369739 [PubMed - indexed for MEDLINE]
104. Int J Obes Relat Metab Disord. 2001 May;25(5):606-12.
Relationship of leisure-time physical activity and occupational activity to the
prevalence of obesity.
King GA, Fitzhugh EC, Bassett DR Jr, McLaughlin JE, Strath SJ, Swartz AM,
Thompson DL.
Department of Exercise Science and Sport Management, The University of Tennessee,
Knoxville, Tennessee, USA. gking@utep.edu
OBJECTIVE: To assess the interaction between leisure-time physical activity
(LTPA) and occupational activity (OA) on the prevalence of obesity. DESIGN:
Secondary data analysis of a population based cross-sectional US national sample
(NHANES III). SUBJECTS: A total of 4889 disease-free, currently employed adults
over age 20 y. MEASUREMENTS: Subjects body mass index (BMI) was categorized as
(1) obese (BMI> or =30 kg/m(2)), or (2) non-obese (BMI<30 kg/m(2)). LTPA was
divided into four categories: (1) no LTPA; (2) irregular LTPA; (3) regular
moderate intensity LTPA; and (4) regular vigorous intensity LTPA. OA was grouped
as (1) high OA and (2) low OA. Age, gender, race-ethnicity, smoking status,
urbanization classification, alcohol consumption and income were statistically
controlled. RESULTS: In all, 16.8% (s.e. 0.7) of the total subject population
were obese (15.1% (s.e. 1.1) of men and 19.1% (s.e. 1.1) of women). Logistic
regression revealed that compared to those who engage in no LTPA and have low
levels of OA, the likelihood of being obese is 42% (95% CI 0.35, 0.96) lower for
those who engage in no LTPA and have high OA, 48% (95% CI 0.32, 0.83) lower for
those who have irregular LTPA and have high levels of OA, and about 50% lower for
all those who have regular LTPA through moderate or vigorous activity levels
regardless of OA level. CONCLUSION: When considering disease free adults above 20
y of age employed in high and low activity occupations, a high level of
occupational activity is associated with a decreased likelihood of being obese.
PMID: 11360141 [PubMed - indexed for MEDLINE]
105. Soc Sci Med. 2001 Feb;52(3):429-39.
Health and cultural factors associated with enrolment in basic education: a study
in rural Ghana.
Fentiman A, Hall A, Bundy D.
Partnership for Child Development, Wellcome Trust Centre for the Epidemiology of
Infectious Disease, Oxford University, UK. atj1@cus.cam.ac.uk
This inter-disciplinary study compares the health status of school-age children
in Ghana, both enrolled and non-enrolled, and examines these results within a
wider socio-economic and socio-cultural context including kinship and livelihood.
Children matched for age and sex who were not enrolled in Primary School were
significantly shorter and more stunted than enrolled children were, and 70% of
all Primary school-age children were anaemic. Young children from farming
communities were significantly more undernourished than children from fishing
communities. Adolescent non-enrolled boys were more heavily infected with
Schistosoma haematobium, and were more likely to be anaemic than enrolled
adolescent boys. The data indicate how health and health related factors may
influence and affect enrolment and how socio-economic indicators, livelihood, and
kinship may also constrain enrolment and, in turn, affect child health. This
study sheds light on the complex factors that may influence enrolment in
education and provides novel data on the similarities and differences between the
health of enrolled and non-enrolled children in rural Ghana.
PMID: 11330777 [PubMed - indexed for MEDLINE]
106. Am J Epidemiol. 2001 Mar 15;153(6):515-22.
Latex sensitization in health care workers and in the US general population.
Garabrant DH, Roth HD, Parsad R, Ying GS, Weiss J.
Department of Environmental and Industrial Health, University of Michigan School
of Public Health and University of Michigan Medical School, Ann Arbor, MI
48109-2029, USA. dhg@umich.edu
Comment in:
Am J Epidemiol. 2001 Jul 15;154(2):190-1.
Am J Epidemiol. 2001 Mar 15;153(6):523-6; discussion 527-8.
Sensitization to natural rubber latex is a prerequisite to type I immediate
hypersensitivity reactions (urticaria, angioedema, anaphylaxis, and allergic
rhinitis) that result from subsequent latex exposure. This study examines
occupations in which latex glove use is common to determine whether it is
associated with increased prevalence odds of latex sensitization (measured by
latex-specific immunoglobulin E antibodies) by using data from 5,512 adults aged
17--60 years from the Third National Health and Nutrition Examination Survey
(1988--1991). After other factors associated with latex sensitization were
controlled for, there was a nonsignificant association between longest-held jobs
in health care and latex sensitization (odds ratio (OR) = 1.49, 95 percent
confidence interval (CI): 0.92, 2.40). For current occupations, latex
sensitization was not associated with health care work in which gloves were used
(OR = 1.17, 95 percent CI: 0.51, 2.65) or with other occupations in which latex
glove use is common (OR = 1.01, 95 percent CI: 0.49, 2.07) compared with other
occupations. Current health care workers who reported not using gloves were at
increased risk of latex sensitization, both among those without a history of
childhood atopy (OR = 2.30, 95 percent CI: 1.04, 5.13) and those with such a
history (OR = 28.04, 95 percent CI: 3.64, 215.97). This odds ratio heterogeneity
suggests that subjects with childhood atopy may be at high risk of latex
sensitization.
PMID: 11257057 [PubMed - indexed for MEDLINE]
107. Int J Obes Relat Metab Disord. 2000 Dec;24(12):1669-76.
Age, education and occupation as determinants of trends in body mass index in
Finland from 1982 to 1997.
Lahti-Koski M, Vartiainen E, Männistö S, Pietinen P.
Department of Nutrition, National Public Health Institute, Helsinki, Finland.
Marjaana.Lahti-Koski@ktl.fi
OBJECTIVE: To investigate trends in body mass index (BMI) and prevalence of
obesity among adults in Finland from 1982 to 1997, and to identify population
groups with increasing obesity. SUBJECTS: Random samples from the national
population register including men and women aged 25-64 y (n = 24604, total).
DESIGN: Four cross-sectional surveys carried out in three areas in Finland every
fifth year since 1982. MEASUREMENTS: Weight and height were measured, and data on
occupation and education level were collected by a self-administered
questionnaire. RESULTS: The mean BMI increased in both genders. In men, the
upward trend was greatest (the increase of 1.3 kg/m2 in 15 y) in the oldest age
group (55-64 y), and was found also (the increase of 0.6 kg/m2) in the youngest
age group (25-34 y), whereas in women, the upward trend was most prominent (the
increase of 0.9 kg/m2) in the youngest age group. BMI increased in all
educational groups in men, but in women the upward trend seemed to be greatest in
the lowest educational group. The upward trends were most prominent among retired
and unemployed men, while in women changes in BMI were similar in all
occupational groups. CONCLUSION: The strongest upward trend in BMI was found in
the oldest men, in the youngest age group in both genders and, in particular,
among men who were outside the labor force. Education is still a strong
determinant of obesity, especially in women, although the social gradient in BMI
has not widened in the 1990s.
PMID: 11126222 [PubMed - indexed for MEDLINE]
108. J Am Geriatr Soc. 2000 Nov;48(11):1501-6.
Lead toxicity in older adults.
Vig EK, Hu H.
Department of Medicine, University of Washington, Seattle, USA.
Recent studies have shown that lead, even at relatively low levels of exposure,
has the potential to harm not only the young and the occupationally-exposed, but
also older people. Because they have been alive for a longer period of time,
older adults have had more potential exposures to lead. They may have been
exposed to lead while working in unregulated occupations, or they may have
encountered more lead in the environment on a daily basis. Several large
epidemiological studies have found that older people have higher blood and bone
lead levels than younger adults. Additionally, sporadic clusters of acute lead
exposure among older adults as a result of activities such as ceramic glaze hobby
work and consumption of moonshine whiskey continue to be reported. After lead
enters the body, it circulates in the blood reaching the soft tissues and bone.
Researchers have learned that lead can hibernate within bone for decades.
Although lead within bone is of uncertain toxicity to bone tissue, conditions of
bone resorption, such as osteoporosis, can cause bone lead to reenter the
bloodstream where it can then re-expose the soft tissue, and, potentially, exert
delayed deleterious effects. Evidence is emerging that blood and bone lead
levels, reflecting relatively modest exposures, are associated with hypertension,
renal insufficiency, and cognitive impairment. Medical treatments that now exist
to slow the rate of bone resorption may maintain lead within bones. On-going
studies evaluating the relationship between body lead stores and both cognitive
and renal impairment, as well as the potential modifying effect of bone
resorption, will help determine whether bone resorption should be retarded
specifically to preserve organ function. Physicians should be aware of potential
past and present lead exposures among their older patients. Ongoing lead exposure
should be prevented. In the future, treatment of osteoporosis may be undertaken
not only to improve bone health but also to prevent mobilization of bone lead
stores and subsequent toxicity.
PMID: 11083332 [PubMed - indexed for MEDLINE]
109. Eur J Clin Nutr. 2000 Sep;54(9):706-14.
A systematic review of socio-economic differences in food habits in Europe:
consumption of fruit and vegetables.
Irala-Estévez JD, Groth M, Johansson L, Oltersdorf U, Prättälä R,
Martínez-González MA.
Department of Epidemiology and Public Health, University of Navarra, Pamplona,
Spain.
OBJECTIVE: To evaluate the differences in the consumption of fruit and vegetables
between groups with different socio-economic status (SES) in the adult population
of European countries. DESIGN: A systematic review of published and unpublished
surveys of food habits conducted between 1985 and 1999 in 15 European countries.
Educational level and occupational status were used as indicators of SES. A
pooled estimate of the mean difference between the highest and the lowest level
of education and occupation was calculated separately for men and women, using
DerSimonian and Laird's random effects model. SETTING: The inclusion criteria of
studies were: use of a validated method for assessing intake at the individual
level; selection of a nationwide sample or a representative sample of a region;
and providing the mean and standard deviation of overall fruit and vegetable
consumption for each level of education or occupation, and separately for men and
women. SUBJECTS: Participants in the individual surveys had to be adults (18-85
y). RESULTS: Eleven studies from seven countries met the criteria for being
included in the meta-analysis. A higher SES was associated with a greater
consumption of both fruit and vegetables. The pooled estimate of the difference
in the intake of fruit was 24.3 g/person/day (95% confidence interval (CI)
14.0-34.7) between men in the highest level of education and those in the lowest
level of education. Similarly, this difference was 33.6 g/person/day for women
(95% CI 22.5-44.8). The differences regarding vegetables were 17.0 g/person/day
(95% CI 8.6-25.5) for men and 13.4 g/person/day (95% CI 7.1-19.7) for women. The
results were in the same direction when occupation instead of education was used
as an indicator of SES. CONCLUSIONS: Although we cannot exclude over-reporting of
intake by those with highest SES, it is unlikely that this potential bias could
fully explain the differences we have found. Our results suggest that an
unhealthier nutrition pattern may exist among adults belonging to lower
socio-economic levels in Europe. SPONSORSHIP: The present study was supported by
the European Union's FAIR programme (FAIR-97-3096).
PMID: 11002383 [PubMed - indexed for MEDLINE]
110. Am J Prev Med. 2000 Jan;18(1):46-53.
Race/ethnicity, social class and their relation to physical inactivity during
leisure time: results from the Third National Health and Nutrition Examination
Survey, 1988-1994.
Crespo CJ, Smit E, Andersen RE, Carter-Pokras O, Ainsworth BE.
Department of Health and Fitness, American University, Washington, DC 20016-8037,
USA. crespoc@america.edu
BACKGROUND: Physical inactivity is more prevalent among racial and ethnic
minorities than among Caucasians. It is not known if differences in participation
in leisure time physical activity are due to differences in social class. Thus,
this paper provides estimates of the prevalence of physical inactivity during
leisure time and its relationship to race/ethnicity and social class. METHODS:
This was a national representative cross-sectional survey with an in-person
interview and medical examination. Between 1988 and 1994, 18,885 adults aged 20
or older responded to the household adult and family questionnaires as part of
the Third National Health and Nutrition Examination Survey . Mexican-Americans
and African-Americans were over-sampled to produce reliable estimates for these
groups. Multiple assessment of social class included education, family income,
occupation, poverty status, employment status, and marital status. RESULTS: The
age-adjusted prevalence (per 100) of adults reporting leisure time inactivity is
lower among Caucasians (18%) than among African-Americans (35%) and
Mexican-Americans (40%). African-American and Mexican-American men and women
reported higher prevalence of leisure time inactivity than their Caucasian
counterparts across almost every variable, including education, family income,
occupation, employment, poverty and marital status. CONCLUSIONS: Current
indicators of social class do not seem to explain the higher prevalence of
physical inactivity during leisure time among African-American and
Mexican-American. More research is needed to examine the effect of other
constructs of social class such as acculturation, safety, social support and
environmental barriers in promoting successful interventions to increase physical
activity in these populations.
PMID: 10808982 [PubMed - indexed for MEDLINE]
111. Ann N Y Acad Sci. 1999;896:461-4.
Morbidity and health--National Health Interview Survey, 1987. In generalized
additive models.
Norris JC, van der Laan M, Block G.
Public Health Institute, Berkeley, California 94704-1104, USA. jcnorris@phi.org
PMID: 10681951 [PubMed - indexed for MEDLINE]
112. Med Sci Sports Exerc. 1999 Dec;31(12):1821-7.
Prevalence of physical inactivity and its relation to social class in U.S.
adults: results from the Third National Health and Nutrition Examination Survey,
1988-1994.
Crespo CJ, Ainsworth BE, Keteyian SJ, Heath GW, Smit E.
American University, Department of Health and Fitness, Washington, DC 20016-8037,
USA. crespoc@american.edu
PURPOSE: This study examines the prevalence of physical inactivity during leisure
time in a national representative sample of U.S. adults. METHODS: Data were
obtained from the Third National Health and Nutrition Examination Survey,
conducted between 1988 and 1994. A total of 18,825 adults aged 20 yr and older
participated in a home interview where information about physical activity,
education, income, occupation, employment, and labor force participation was
obtained. RESULTS: The prevalence of physical inactivity among U.S. adults was
23%, with more women (28%) than men (17%) reporting being inactive during their
leisure time. Additionally, inactivity is more common among in social class such
as persons who are less educated, living below the poverty line, living in
households with income below 20,000 dollars, and who are retired. In every
category of social class, women experienced a higher prevalence of physical
inactivity than men. CONCLUSIONS: We conclude that social class is associated
with physical inactivity and that more research is needed to better understand
the effect that other social and environmental factors have on sedentary
behaviors in our society.
PMID: 10613434 [PubMed - indexed for MEDLINE]
113. Public Health Nutr. 1998 Mar;1(1):5-21.
The nutrition transition and its health implications in lower-income countries.
Popkin BM.
Department of Nutrition, University of North Carolina at Chapel Hill, USA.
POPKIN@UNC.EDU
OBJECTIVE: This article reviews information on the rapid changes in diet,
activity and body composition that lower- and middle-income countries are
undergoing and then examines some of the potential health implications of this
transition. DESIGN AND SETTING: Data came from numerous countries and also from
national food balance (FAOSTAT) and World Bank sources. Nationally representative
and nationwide surveys are used. The nationally representative Russian
Longitudinal Monitoring Surveys from 1992-96 and the nationwide China Health and
Nutrition Survey from 1989-93 are examined in detail. RESULTS: Rapid changes in
the structure of diet, in particular associated with urbanization, are
documented. In addition, large changes in occupation types are documented. These
are linked with rapid increases in adult obesity in Latin America and Asia. Some
of the potential implications for adult health are noted. CONCLUSIONS: The rapid
changes in diet, activity and obesity that are facing billions of residents of
lower- and middle-income countries are cause for great concern. Linked with these
changes will be a rapid increase in chronic diseases. Little to date has been
done at the national level to address these problems.
PMID: 10555527 [PubMed - indexed for MEDLINE]
114. Int J Cancer. 1999 Nov 26;83(5):620-4.
Ecological study on the risks of esophageal cancer in Ci-Xian, China: the
importance of nutritional status and the use of well water.
Yokokawa Y, Ohta S, Hou J, Zhang XL, Li SS, Ping YM, Nakajima T.
Department of Hygiene, Shinshu University, School of Medicine, Matsumoto, Japan.
Our purpose was to determine the environmental risks in the development of
esophageal cancer in Ci-Xian, which has one of the highest incidences of
esophageal cancer in China. The subjects included 404, 352 and 400 inhabitants
living in high-, medium-, and low-incidence areas of esophageal cancer, as well
as 301 esophageal cancer patients. A food intake-frequency survey using a 7-day
weighted inventory questionnaire was conducted on these individuals. Questions on
occupation, working conditions, income per year, family disease history, medical
complaints, and demographic features were also included in the questionnaire. The
levels of nitrogen compounds in selected samples of well water were also measured
in each of the 3 areas. Clear-cut differences in food intake were seen among
inhabitants living in the 3 different areas, suggesting that regional differences
in nutritional styles do exist. In both males and females, the intake of
potatoes, fruit, vegetables, and meat were significantly lower in inhabitants
living in the high-incidence area than in the other inhabitants, much the same as
that of cancer patients. A low intake of carotene, and vitamins A and C was also
seen in populations living in the high-incidence area of esophageal cancer. The
well water polluted with nitrogen compounds was significantly related to the high
incidence of esophageal cancer. In contrast, tobacco, alcohol consumption, and
the intake of pickled vegetables and moldy foods did not relate to the different
incidence rates. Our results suggest that low intake of fruit, vegetables,
potatoes and meat, and the quality of well water may be important factors in the
development of esophageal cancer in Ci-Xian. Copyright 1999 Wiley-Liss, Inc.
PMID: 10521797 [PubMed - indexed for MEDLINE]
115. Women Health. 1999;29(3):13-29.
The association between extent of employment and hypertension among women
participants of the Second National Health and Nutrition Survey.
Rose KM, Newman B, Bennett T, Tyroler HA.
School of Public Health at the University of North Carolina at Chapel Hill 27514,
USA. kathy.rose@sph.unc.edu
The association between extent of employment and hypertension was examined among
3,824 women participants of the Second National Health and Nutrition Examination
Survey. Women in three employment groups (full-time, part-time, and short-term)
were compared to homemakers. In covariate-adjusted, logistic regression models,
women employed full-time had a somewhat lower, but not significantly different,
prevalence of hypertension (OR = 0.8, 95% CI = 0.7, 1.1), whereas both part-time
(OR = 0.6, 95% CI = 0.4, 0.7) and short-term (OR = 0.5, 95% CI = 0.4, 0.7)
workers had significantly lower prevalences. Associations did not tend to vary by
age, ethnicity, or occupation. Employment does not appear to increase the risk of
hypertension in women; in fact, moderate levels were associated with lower risk.
PMID: 10466508 [PubMed - indexed for MEDLINE]
116. Nutr Metab Cardiovasc Dis. 1999 Jun;9(3):125-32.
Modifiable risk factor levels of coronary heart disease survivors in a
middle-aged workforce.
Metcalf PA, Scragg RK, Swinburn B.
Department of Statistics, School of Medicine, University of Auckland, New
Zealand.
BACKGROUND AND AIM: Coronary heart disease (CHD) is common in New Zealand. Risk
factors for CHD are modifiable or non-modifiable. Modifiable risk factor levels
of CHD survivors were compared with those without such a history (non-CHD).
METHODS AND RESULTS: Participants were from a cross-sectional survey of 5,656
workers aged > or = 40. CHD survivors were 73 general practitioner (GP)-confirmed
participants with a history of hospitalisation for CHD. There were no significant
differences in mean blood pressure levels between CHD survivors and non-CHD
workers after adjusting for age, gender and ethnicity, but current use of
antihypertensive medications was higher in CHD survivors (34.2%) than non-CHD
workers (8.1%); p < 0.001. CHD survivors had higher, similarly adjusted, mean
serum total cholesterol, triglyceride and lower HDL-cholesterol levels, and their
reported carbohydrate, fibre, polyunsaturated fat intakes and ratio of
polyunsaturated to saturated fat intakes were higher and total fat, saturated fat
and monounsaturated fat intakes were lower. CHD survivors ate fewer servings of
red meats per month and more servings of fruit, and cereal, and number of cups of
milk. Salt added to meals was lower and margarine use higher in CHD survivors.
There were no significant differences in the proportions of those who exercised
regularly, or were current cigarette smokers. However, more CHD survivors (57.5%)
than non-CHD workers (33.1%) were ex-smokers p < 0.001, who had stopped smoking
at a higher mean (se) age (41.1 (1.36) vs 37.6 (0.20) years respectively; p =
0.012). CONCLUSIONS: A large proportion of CHD survivors were dyslipidaemic,
despite consuming a lower fat, higher fibre and carbohydrate diet. More than 50%
of CHD survivors were ex-cigarette smokers, who had given up smoking at a later
age than non-CHD workers. These high-risk CHD survivors would benefit from more
aggressive measures aimed at correcting their dyslipidaemias.
PMID: 10464785 [PubMed - indexed for MEDLINE]
117. Pediatrics. 1999 Jun;103(6):e85.
Influence of the home environment on the development of obesity in children.
Strauss RS, Knight J.
Division of Pediatric Gastroenterology and Nutrition, University of Medicine and
Dentistry of New Jersey, Robert Wood Johnson School of Medicine, New Brunswick,
New Jersey 08903, USA. strausrs@rwja.umdnj.edu
CONTEXT: Obesity is the most common health problem facing children. The most
recent data from the National Health and Nutrition Examination Survey III suggest
that 22% of children and adolescents are overweight and that 11% are obese.
OBJECTIVE: To investigate prospectively the association between the home
environment and socioeconomic factors and the development of obesity in children.
DESIGN: Prospective cohort study. SETTING: The National Longitudinal Survey of
Youth. Population. A total of 2913 normal weight children between the ages of 0
and 8 years were followed over a 6-year period. We examined the roles of race,
marital status, maternal education, family income, and parental occupation, as
well as standardized measures of the home environment (The Home Observation for
Measurement of the Environment [HOME]-Short Form) on the development of childhood
obesity. PRIMARY OUTCOME MEASURE: Incidence of obesity. Obesity was defined as a
body mass index >95th percentile for age and gender at the 6-year follow-up.
RESULTS: Maternal obesity was the most significant predictor of childhood obesity
(OR: 3.62 [2. 65-4.96]). The HOME-Short Form cognitive scores and household
income were also significant predictors of childhood obesity (OR, low
HOME-cognitive: 2.64 [1.48-4.70], medium HOME-cognitive: 2.32 [1. 39-3.88]; low
income: 2.91 [1.66-5.08], medium income: 2.04 [1.21-3. 44]). Children who lived
with single mothers were also significantly more likely to become obese by the
6-year follow-up, as were black children, children with nonworking parents,
children with nonprofessional parents, and children whose mothers did not
complete high school. Neither the child's gender nor the HOME-emotional scores
contributed to the development of obesity. After controlling for the child's
initial weight-for-height z-score, maternal body mass index, race, marital
status, occupation, education, and HOME emotional scores, only the HOME cognitive
score and family income remained significant predictors of childhood obesity.
CONCLUSION: Children with obese mothers, low family incomes, and lower cognitive
stimulation have significantly elevated risks of developing obesity, independent
of other demographic and socioeconomic factors. In contrast, increased rates of
obesity in black children, children with lower family education, and
nonprofessional parents may be mediated through the confounding effects of low
income and lower levels of cognitive stimulation.
PMID: 10353982 [PubMed - indexed for MEDLINE]
118. J Am Diet Assoc. 1999 Feb;99(2):184-90.
Dietary intake of modernizing Samoans: implications for risk of cardiovascular
disease.
Galanis DJ, McGarvey ST, Quested C, Sio B, Afele-Fa'amuli SA.
Injury Prevention and Control Program, Hawaii Department of Health, Honolulu
96813, USA.
OBJECTIVE: To describe the dietary intake of American and Western Samoans, with
emphasis on nutrients conventionally related to risk factors for cardiovascular
disease. DESIGN: Cross-sectional dietary survey. Intake estimates were based on
24-hour recall interviews. SUBJECT: Community-based samples of 946 men and women
(455 American Samoans, 491 Western Samoans) aged 25 to 55 years. STATISTICAL
ANALYSES: Tests of differences in means (t tests) and proportions (chi 2 tests).
Correlation and multivariate linear regression analyses were conducted to
describe correlates of energy and nutrient intakes. RESULTS: Few differences were
noted between the energy and nutrient intakes of men and women, but substantial
differences were found between residents of American Samoa and those of the less
modernized country of Western Samoa. American Samoans consumed significantly more
energy as carbohydrate (47% vs 44%) and protein (18% vs 13%) and less as fat (36%
vs 46%) and saturated fat (16% vs 30%). Energy-adjusted intakes of cholesterol
and sodium were higher among American Samoans. These differences persisted after
adjustment for age, gender, years of education, occupation, and categories of a
10-point material lifestyle score. Samoans in the lowest category of material
lifestyle had significantly lower energy-adjusted intakes of protein,
cholesterol, and sodium and higher intakes of saturated fat than those in the
upper 2 categories. Additional analyses described the contribution of specific
foods to the intakes of energy and macronutrients. CONCLUSIONS/APPLICATIONS: The
observed energy and nutrient intake patterns are consistent with previously
reported levels of obesity and risk factors for cardiovascular disease among
Samoans and suggest dietary modification for those at highest risk. Dietetics
practitioners who counsel Samoan and other Pacific Islander clients should be
aware of these intake patterns, which seem particularly malleable to levels of
personal income. More generally, results from this study illustrate that the food
choices of certain ethnic groups may be profoundly affected by the process of
modernization within a country or by migration to a more economically developed
locale.
PMID: 9972185 [PubMed - indexed for MEDLINE]
119. Stud Fam Plann. 1998 Dec;29(4):373-87.
Looking locally at China's one-child policy.
Short SE, Fengying Z.
Department of Sociology, Brown University, Providence, RI 02912, USA.
Of all the reforms and policies set in motion in the early 1980s in China, the
one-child policy has been called the most far-reaching in its implications for
China's population and economic development. Almost two decades later, little is
known about what the policy looks like across local neighborhoods and villages.
To sketch a more general picture of the one-child policy, this article presents
panel data from three waves of the China Health and Nutrition Survey (1989, 1991,
and 1993) collected in 167 communities in eight provinces. Local policy,
including policy strength and policy incentives and disincentives, is detailed
separately for urban and rural areas. These data confirm that no single one-child
policy exists; policy varied considerably from place to place and within
individual communities during the 1989-93 period.
PIP: China's 1-child policy was introduced in 1979, giving incentives to couples
who pledged to have only 1 child, and penalizing couples who bore three or more
births. Second births were discouraged, but not penalized. However, in 1981 and
1982, in urban and then rural areas, policy changed to forbid second births
except under extraordinary circumstances. By 1983, mandatory IUD insertions,
abortions, and sterilizations were reported. Policy, however, eased in 1984 and
further during the late 1980s. China's 1-child policy will have a major long-term
impact upon the country's population and economic development. Panel data are
presented from the 1989, 1991, and 1993 waves of the China Health and Nutrition
Survey conducted in 167 communities in 8 provinces. Local policy, including
policy strength, incentives, and disincentives, is described separately for urban
and rural areas. The data indicate that no single 1-child policy exists. Rather,
policy varied considerably from place to place and within individual communities
during 1989-93.
PMID: 9919631 [PubMed - indexed for MEDLINE]
120. Popul Trends. 1998 Winter;(94):35-41.
Longitudinal study of socio-economic differences in the incidence of stomach,
colorectal and pancreatic cancers.
Brown J, Harding S, Bethune A, Rosato M.
Using the ONS Longitudinal Study, the incidence of stomach, colorectal and
pancreatic cancers from 1976-90 was examined for men and women aged 30 years and
over by their housing tenure and occupational social class. Large socio-economic
differences in the incidence of stomach cancer for both men and women were found.
The pattern of colorectal cancer was less clear, with women in more advantaged
social groups experiencing higher incidence while for men there was no
significant association. Pancreatic cancer showed no association with
socio-economic status. Consistent findings with each indicator strengthen the
interpretation of the results. Risk factors for these cancers are known to vary
by socio-economic status, and this study demonstrates the importance of continued
monitoring of the distribution of cancer incidence.
PMID: 9885835 [PubMed - indexed for MEDLINE]
121. Acta Med Austriaca. 1998;25(2):69-71.
[Different occupational groups of women and selected nutrition-related risk
factors for osteoporosis]
[Article in German]
Rásky E, Freidl W, Schmeiser-Rieder A, Scheuringer C, Stronegger WJ.
Institut für Sozialmedizin, Universität Graz. eva.rasky@kfunigraz.ac.at
This paper studies the prevalence of risk factors considered responsible for
osteoporosis in women of 4 occupational groups: farmers, blue collar workers,
white collar workers/civil servants and housewives. We analyzed nutritional
factors associated with osteoporosis in the scientific literature. The total
sample comprises of 2185 individuals of which 658 women were taken into the
analyses. The data set was based on a health survey conducted in 10 selected
rural communities of Styria in Austria between 1995 and 1996. Sociodemographic
data, lifestyles, internal and external resources as well as indicators off
ill-health were surveyed through standardized personal interviews. The results
show that the women of the 4 occupational groups were differently strained
regarding nutritional risk factors. Our results suggest that efficient
intervention programs to prevent osteoporosis need to specifically focus on the
various life contexts of women.
PMID: 9681047 [PubMed - indexed for MEDLINE]
122. J Epidemiol. 1998 Jun;8(2):106-15.
Relationship of food intake and dietary patterns with blood pressure levels among
middle-aged Japanese men.
Takashima Y, Iwase Y, Yoshida M, Kokaze A, Takagi Y, Taubono Y, Tsugane S,
Takahashi T, Iitoi Y, Akabane M, Watanabe S, Akamatsu T.
Department of Public Health, Kyorin University School of Medicine, Mitaka, Japan.
Erratum in:
J Epidemiol 1998 Oct;8(4):257. Tsubono Y [corrected to Taubono Y].
To investigate the relationship of food intake habits and dietary patterns to
blood pressure, a cross-sectional study was conducted for 473 middle-aged
Japanese males. After adjustment for age, residence, occupation, body mass index
and alcohol consumption, mean systolic and diastolic blood pressure (SBP and DBP)
were inversely associated with each intake frequency of dairy products, coffee,
fruits, egg, beef, pork and chicken. The adjusted mean SBP and DBP of the
individuals with 'all (= three)' of the following three dietary habits; 'once and
over/wk of dairy products', 'once and over/wk of fruits', and 'three times and
over/wk of beef, pork or chicken', were 7.4 mmHg and 6.9 mmHg lower (p < 0.001,
for each) than those of 'zero or one' group. According to the analyses on 3-days
weighed food records of 157 volunteers, the adjusted mean daily intake of total
protein, animal protein and potassium were markedly higher in the 'two' or the
'three' group than in the 'zero or one' group (p < 0.05, for each). These results
suggest that habitual intake of dairy products, fruits, and meat or chicken may
be associated with the reduction of blood pressure possibly through the intake of
protein and potassium.
PMID: 9673080 [PubMed - indexed for MEDLINE]
123. Mem Inst Oswaldo Cruz. 1997 Sep-Oct;92(5):707-15.
Factors involved in Schistosoma mansoni infection in rural areas of northeast
Brazil.
Coutinho EM, Abath FG, Barbosa CS, Domingues AL, Melo MC, Montenegro SM, Lucena
MA, Romani SA, Souza WV, Coutinho AD.
Departamento de Parasitologia, Centro de Pesquisas Aggeu Magalhães-FIOCRUZ,
Recife, PE, Brasil.
Two contiguous villages in Tracunhaém county (State of Pernambuco), endemic for
schistosomiasis, were studied: Itapinassu (138 inhabitants) and São Joaquim (91
inhabitants). Agriculture predominates in the former region while ceramics is the
main activity in the latter. Although no statistical difference was found
regarding prevalence, severe infection (> 400 epg) predominated in Itapinassu,
probably related to the kind of occupation. No association was found between
parasite burden and severity of disease, in spite of the high infection rates for
Schistosoma mansoni in both communities (approx. 60%). Typical epidemiological
features of schistosomiasis such as age-related prevalences and intensities of
infection (high in children, low in adults) were also mutual characteristics.
Nutritional status determined through anthropometric evaluation was carried out
by measuring specific anthropometric indicators. A deficit of energy intake, as
well as vitamin A and riboflavin deficiencies were detected. The prevalence of
moderate or severe undernutrition in patients under 18 years old was 21.9% in
Itapinassu and 24.1% in São Joaquim. In this group an association was found
between prevalence of schistosomiasis and chronic undernutrition. Similarly, for
patients over 18 year old the prevalence of undernutrition was higher than 20%.
However, in this case no association between nutritional status and either
prevalence of schistosomiasis or parasite burden could be detected. The two
communities had not been treated for eight years.
PIP: Patterns of schistosomiasis infection were compared in two contiguous
endemic villages in Northeast Brazil's Tracunhaem County (Pernambuco State):
Itapinassu (138 inhabitants) and Sao Joaquim (91 inhabitants). The overall
prevalence of schistosomiasis in Tracunhaem State was 58.7%; this rate was 61.6%
in Itapinassu and 54.2% in Sao Joaquim. Severe infection (400 epg) was more
prevalent in Itapinassu (35.1%) than Sao Joaquim (13.3%) and ultrasound revealed
more severe pathologic changes (e.g., periportal fibrosis, right liver lobe
shrinkage, left lobe and spleen enlargement) in the former village. The higher
prevalence of severe infection in Itapinassu is likely related to the
predominance of agricultural occupations; in Sao Joaquim, most residents are
engaged in ceramics. Schistosomiasis prevalence was significantly positively
associated with increasing age, male sex, residence in the village for more than
5 years, daily water contact, fishing, laundering, less than a 10 m distance from
an infected stream, lack of cesspools, and chronic undernutrition. A deficit of
energy intake, as well as vitamin A and riboflavin deficiencies, was detected in
both villages. The role of each of these factors (especially nutritional status)
will be analyzed further in order to develop an integrated model for local
control of the disease.
PMID: 9566243 [PubMed - indexed for MEDLINE]
124. Eur J Clin Nutr. 1997 Oct;51(10):698-702.
Vitamin A deficiency among adolescent female garment factory workers in
Bangladesh.
Ahmed F, Hasan N, Kabir Y.
Institute of Nutrition and Food Sciences, University of Dhaka, Bangladesh.
OBJECTIVE: To investigate the prevalence of vitamin A deficiency among adolescent
female factory workers in Bangladesh, and examine the association between various
factors and vitamin A status. DESIGN: A cross-sectional study. SETTING: Garment
factories in Dhaka city, Bangladesh. SUBJECTS: Three hundred and eighty eight
adolescent girls aged 12-19 y from ten garment factories were selected randomly
for the present study. Information on socio-economic conditions and usual pattern
of dietary intake were obtained by interview. Anthropometric data and blood
samples were collected following the interview. RESULTS: By NCHS reference
standard, 15.5% of the participants were thin (< 90% Wt/Ht) and about 7%
overweight (> 120% Wt/Ht). In about 56%, serum vitamin A level was below the
adequate level of 1.05 mumol/l, with 14% having vitamin A deficiency (< 0.70
mumol/l). Forty four per cent of the participants were found to be anaemic
(haemoglobin < 120 g/l). Food frequency data on vitamin A rich foods revealed
that a large percentage of the participants do not take eggs (41%), milk (64%),
liver (85%) and sweet pumpkin (85%); while about 40% of the girls take dark green
leafy vegetables (DGLV) and 17% take small fish at least four servings a week.
The girls who consumed four or more servings per week of DGLV had significantly
higher serum vitamin A level than the girls who took three servings or less.
There was a significant positive association between the level of serum vitamin A
and frequency of intake of DGLV (r = 0.12; P = 0.023). When age, level of
education, percapita income, haemoglobin concentration, serum protein
concentration, menstruation at the time of blood collection, prevalence of
current morbidity, frequency of intake of egg, milk, small fish, DGLV, liver and
sweet pumpkin were accounted for by multiple regression analysis, a strong
relationship was found for serum vitamin A concentration with age, menstruation,
haemoglobin level and frequency of intake of DGLV. For every unit change in the
frequency of consumption of DGLV, there was 0.013 mumol/l change in serum vitamin
A level whilst taking other factors into account. CONCLUSION: The data show that
there is a high prevalence of subclinical vitamin A deficiency among the
adolescent female garment factory workers in Bangladesh, although the
anthropometric indices suggest that they do not suffer from acute under
nutrition. Consumption of DGLV appears to have an important relation with the
vitamin A status of these girls.
PIP: A cross-sectional study of 388 adolescent girls 12-19 years of age employed
in garment factories in Dhaka, Bangladesh, revealed a high prevalence of
subclinical vitamin A deficiency despite a lack of anthropometric evidence of
acute undernutrition. Only 15.5% of participants were classified as thin (under
90% weight-for-height by US National Center for Health Statistics reference
standards). Mean hemoglobin concentration was 119.7 g/l (range, 74-157 g/l).
Assuming a cut-off point of under 120 g/l, 44% of these young women were anemic.
The average serum vitamin A concentration was 1.04 mcgmol/l (range, 0.31-2.47
mcgmol/l); 56.2% of girls had a low (under 1.05 mcgmol/l) serum vitamin A level
and 14.2% were vitamin A deficient (under 0.70 mcgmol/l). Mean frequencies of
intake of egg, milk, small fish, and dark green leafy vegetables were 1.3, 0.8,
2.1, and 3.4 servings per week, respectively. 85% did not eat any liver or sweet
pumpkin in the week preceding the interview. Serum vitamin A was significantly
lower among participants who consumed less than 4 servings of milk and/or dark
green leafy vegetables per week than among those who consumed 4 or more servings
of these foods. Stepwise multiple regression analysis indicated that age,
menstruation, hemoglobin concentration, and frequency of intake of dark green
leafy vegetables were significantly independently related to serum vitamin A
level. For every unit change in the frequency of consumption of dark green leafy
vegetables, there was a 0.013 mcgmol/l change in serum vitamin A level.
PMID: 9347291 [PubMed - indexed for MEDLINE]
125. J Am Diet Assoc. 1997 Aug;97(8):851-5.
The role of clinical dietitians as perceived by dietitians and physicians.
Boyhtari ME, Cardinal BJ.
Detroit Medical Center, Mich, USA.
OBJECTIVE: The purpose of this study was to examine dietitians' and physicians'
perceptions regarding the role of clinical dietitians. SUBJECTS AND DESIGN: Four
hundred ten physicians and clinical dietitians were randomly identified from the
American Board of Medical Specialties Directory of Board Certified Medical
Specialists and from Michigan district dietetic association directories. A survey
containing demographic, situational, and role and responsibility questions was
administered. STATISTICAL ANALYSES PERFORMED: Cronbach's alpha coefficient was
computed to determine the internal consistency of the measurement instrument. A
series of two-tailed t tests was performed to determine between-group differences
on the perception questions. Analysis of covariance was completed to control for
potential confounds. chi 2 Tests were performed to determine the relationship
among a change of diet order question and participants' occupation, area of
specialty, and practice setting. RESULTS: Of the surveys mailed, 73% were
returned and 58% overall were usable. The internal consistency of the measure was
.72. Most dietitians' and physicians' responses to the role and responsibility
questions differed significantly, with particularly large differences noted for 6
of 10 questions; however, "total score" differences were not significant.
Significant associations were found for the level of specialization and type of
occupation on the change of diet order question. APPLICATION/CONCLUSIONS: Routine
contact, communication, and interaction between physicians and dietitians are
vital if physicians are to know dietitians' responsibilities and competencies and
collaborate with them when providing medical nutrition therapy to patients.
Future studies that differentiate areas of responsibility of clinical dietitians
and inquire into dietitians' and physicians' interactions during their education
or training may provide further insights into this topic.
PMID: 9259705 [PubMed - indexed for MEDLINE]
126. Metabolism. 1997 Jun;46(6):625-33.
Prospective 10-year evaluation of hypobetalipoproteinemia in a cohort of 772
firefighters and cross-sectional evaluation of hypocholesterolemia in 1,479 men
in the National Health and Nutrition Examination Survey I.
Glueck CJ, Kelley W, Gupta A, Fontaine RN, Wang P, Gartside PS.
Cholesterol Center, Jewish Hospital of Cincinnati, OH 45229, USA.
Our specific aim in a 10-year prospective study of 772 Cincinnati firemen
(predominantly aged 26 to 46 years) was to determine the prevalence, attributes,
and etiology of persistent hypobetalipoproteinemia, defined by entry low-density
lipoprotein cholesterol (LDLC) less than 75 mg/dL. A second specific aim was to
cross-sectionally assess hypocholesterolemia (defined by total serum cholesterol
[TC] < 130 mg/dL) in 1,314 white and 165 black men aged 26 to 46 years in the
National Health and Nutrition Examination Survey (NHANES I). The 141 black and
631 white firemen had 4,973 person-years of follow-up time (median, 7.1 yr/man).
Of 772 men, 44 (5.7%) had entry LDL levels less than 75 mg/dL; they had a mean
follow-up time of 7.3 yr/man. Of these 44 men, there were 12 (1.8% of the cohort)
with entry LDLC less than 75 mg/dL, and at least 67% of their follow-up LDLC
levels were less than 75. Their mean entry TC and LDLC levels were low (130 and
58 mg/dL), mean triglyceride (TG) was low (63 mg/dL), and mean high-density
lipoprotein cholesterol (HDLC) was high (60 mg/dL), LDLC remained at less than 75
mg/dL in 81% of their follow-up samples. Their mean entry and follow-up
cholesterol and LDLC did not differ (P > .1, 130 v 133 mg/dL and 58 v 63 mg/dL).
Compared with 32 men with entry LDLC less than 75 mg/dL but with less than 87% of
follow-up LDLC less than 75 mg/dL, the 12 men with persistently low LDLC had
lower mean Quetelet indices and diastolic blood pressure at entry (2.36 v 2.58, P
= .056; 73 v 80 mm Hg, P = .03) and on follow-up study (2.45 v 2.69, P = .04; 72
v 79 mm Hg, P = .05). Of 12 men with persistently low LDLC, two had truncated
apolipoprotein (apo) B (familial hypobetalipoproteinemia, two had the apo E
genotype 2/3, and two had acquired hypobetalipoproteinemia that antedated
mortality from melanoma by 9 years and from alcoholism by 2 years. Comparable to
white and black firemen aged 26 to 46 years, 2.9% and 3.6% of whom had entry
serum TC less than 130 mg/dL, of 1,314 white and 165 black men in the NHANES I
study (aged 26 to 46), 1.8% and 3.6% had hypocholesterolemia (entry TC < 130
mg/dL). Daily mean calorie, fat, and protein intake (grams per day) did not
differ (P > .05) in men with entry TC less than 130 mg/dL compared with those
with TC 130 to 230 or greater than 230 mg/dL. Hypocholesterolemia in white and
black men in NHANES I could not be attributed to hypocaloric intake or to
protein, fat, or carbohydrate undernutrition. There appear to be racial
differences in the prevalence of hypocholesterolemia. Blacks comprised 18% of the
firemen's cohort but 42% of those with persistent hypobetalipoproteinemia; among
NHANES I subjects, 3.6% of blacks were hypocholesterolemic versus 1.8% of whites.
Unless persistent hypobetalipoproteinemia reflects an underlying disease,
alcoholism, etc., it is often heritable, and may be associated with a reduced
likelihood of coronary heart disease (CHD) and with increased longevity.
PMID: 9186296 [PubMed - indexed for MEDLINE]
127. Aust N Z J Public Health. 1997 Apr;21(2):147-54.
Whose diet has changed?
Dobson A, Porteous J, McElduff P, Alexander H.
Department of Statistics, University of Newcastle, Callaghan, NSW.
The same questions about diet were asked in two community-based surveys conducted
in the Hunter Region of New South Wales in 1983 and 1994. There were substantial
changes in diet over the period; for example, the proportion of respondents who
reported using low-fat or skim milk increased from 25 per cent to 51 per cent,
the proportion eating meat fewer than five times a week doubled from 21 per cent
to 42 per cent and the proportion eating fewer than three eggs per week increased
from 55 per cent to 80 per cent. In both surveys, women reported eating a
healthier diet than men, and older people and those of higher socioeconomic
status reported better diets than younger people or people with less education or
lower status occupations. The surprising finding was that over the 11-year period
the changes in patterns of food consumption were remarkably similar across all
strata of the population. The conclusions are that wide-spread dietary change is
possible. However, the changes in the last decade related mainly to reducing the
risk of cardiovascular disease; similar behavioural changes to reduce the risk of
diet-related cancer are required.
PMID: 9161069 [PubMed - indexed for MEDLINE]
128. Ann Trop Paediatr. 1996 Dec;16(4):327-33.
Maternal factors influencing the occurrence of low birthweight in northern
Vietnam.
Dinh PH, To TH, Vuong TH, Höjer B, Persson LA.
Institute for Protection of Children's Health, Hanoi, Vietnam.
The relationship between the birthweight of newborn infants and their mothers'
health characteristics as well as socio-economic status were studied in 1474
consecutive deliveries from eight areas in the delta region of north Vietnam. The
results showed that the proportion of low birthweight (LBW) infants varied from
7.9% to 12.5%. Body mass index (BMI) of the mothers, good nutrition during
pregnancy and maternity leave before delivery were negatively associated with the
occurrence of LBW. The association between chronic energy deficiency (low BMI)
and LBW was seen only among the farming women. Measures should be taken to reduce
the workload and to supply sufficient food for pregnant women, and special
priority should be given to rural areas.
PIP: This study examines the prevalence of low-birth-weight (LBW) deliveries
among a sample of women from 17 communes in five provinces in the Red River delta
region of north Vietnam during 1992-93. The final sample included 1474
consecutive deliveries from five rural and three urban areas. Trained medical
staff measured the weight and height of newborns and mothers after delivery. Body
mass index (BMI) was used to determine maternal energy deficiency. Gestational
age was determined by measuring the time interval between the last menstrual
period and delivery. Maternal diet was categorized as very poor (rice and
vegetables only), poor (rice and some supplementary food), or sufficient (rice
and enough supplementary food). Findings indicate that LBW deliveries amounted to
7.9% in rural Ha Tay (health center deliveries), 10.5% in rural Nam Ha (health
center deliveries), and 8.5% in rural Thai Binh (home deliveries). The number of
LBW deliveries was very low in urban Hanoi and in the Nam Dinh factory hospital.
LBW infants did not vary by gender. LBW deliveries were more prevalent for
first-born children (12% among girls and 7% among boys). Farming mothers were
twice as likely to have a LBW delivery. LBW deliveries were less common among
mothers who had made over four prenatal visits. An increase in the likelihood of
delivering a LBW infant was associated with insufficient food intake, heavy
physical work during pregnancy, and chronic energy deficiency. LBW was
independently associated with BMI, food availability during pregnancy, maternity
leave before delivery, and parity. Farming mothers with a BMI under 18.5 had
three times the risk of having a LBW delivery than normal mothers. 94% of farming
mothers and only 40% of nonfarming mothers had insufficient food intake. LBW
deliveries were more common in the summer and autumn. 8% showed some disease
during pregnancy, such as toxemia, infectious diseases, or other diseases. LBW
risk doubled with any of these conditions.
PMID: 8985530 [PubMed - indexed for MEDLINE]
129. Am J Ind Med. 1996 Sep;30(3):331-40.
Risk factors for coronary heart disease among firefighters in Cincinnati.
Glueck CJ, Kelley W, Wang P, Gartside PS, Black D, Tracy T.
Cholesterol Center, Jewish Hospital of Cincinnati, OH 45229, USA.
Since 1984, coronary heart disease (CHD) risk factors have been prospectively
assessed among Cincinnati firefighters free of CHD at study entry. In total, 806
firemen with a mean age of 37 years at entry have been followed for 6.4 years on
average, contributing 5,173 person-years. CHD risk factors were measured every
1-4 years and included weight, blood pressure, cigarette use, fasting glucose,
and lipid profile. When, in aggregate, these CHD risk factors were found to be in
a high risk range, suggestions were made serially to reduce CHD risk. A composite
high CHD risk factor score led to an exercise electrocardiogram (ECG) with
thallium scan, which was repeated every 1-4 years. Myocardial infarction (MI)
occurred in 7 men, with 1.35 MIs/1,000 man-years; 15 others developed CHD, with
4.25 MI + CHD/1,000 man-years. The firefighters' MI event rate (1.35 MIs/1,000
man-years) was lower (but not significantly, p > 0.1) than that for employed 30-
to 39-year-old men free of CHD at entry (2.07/1,000 man years), who had an
average follow-up of 5.4 years in the NHANES I study. At study entry, the 22 men
who later developed CHD (vs. the 784 who did not develop CHD) were older (p =
.0001), smoked more (p = .0001), and were more likely to have first degree
relatives with CHD before age 60 (p = .017). After covariance adjusting for age,
race, and Quetelet index, men with CHD (vs. those CHD free) had higher systolic
and diastolic blood pressures (p = .0001, .0001), higher LDL cholesterol (p =
.04), higher total cholesterol (p = .014), and higher triglycerides (p = .03). By
Poisson regression, significant independent predictors of CHD events were age (p
= .0007), cigarette smoking (p = .001), diastolic blood pressure (p = .056), and
family history of CHD at age < or = 60 (p = .048). Men who later developed CHD
and those without CHD did not differ by history of smoke inhalation (p > 0.3).
The calculated ratio of savings to cost attributable to the program per year was
5.9/1 ($258,500/$43,600). In the current study, firefighting as an occupation was
not associated with increased CHD event rates. CHD events that did develop were,
for the most part, associated with modifiable CHD risk factors.
PMID: 8876802 [PubMed - indexed for MEDLINE]
130. Eur J Clin Nutr. 1996 Aug;50(8):560-4.
Socio-economic influences on gender inequalities in child health in rural
Bangladesh.
Rousham EK.
Department of Anatomy and Human Biology, University of Western Australia,
Nedlands, Perth, Western Australia.
OBJECTIVE: To investigate gender inequalities in child growth and nutritional
status in relation to socio-economic status in Bangladesh. DESIGN: A 16-month
longitudinal study of child growth measuring anthropometric and socio-economic
status. SETTING: A rural area of Jamalpur district, northern Bangladesh.
SUBJECTS: 1366 children from 2 to 6 years of age. METHODS: Child height and
weight were measured monthly. Morbidity, food intake and health-seeking
behaviours were assessed fortnightly. Multivariable analyses were performed on
the growth and nutritional status of male and female children in relation to
socio-economic factors including father's occupation, parental education, birth
order and family size. RESULTS: There was no evidence of gender bias in farming
and trading/employee households but landless female children had significantly
poorer height-for-age (P < 0.001) and weight-for-age (P < 0.001) than their male
counterparts. During a period of natural disaster, a statistically significant
interaction was observed between father's occupation and sex (P < 0.05) such that
the combination of being female and being landless was more detrimental to
nutritional status than either variable alone. Over the following 16-months,
catch-up-growth was apparent in landless female children who grew significantly
more in height-for-age (P < 0.001) and weight-for-age (P < 0.001) than their male
counterparts. CONCLUSIONS: Gender inequalities in health in Bangladesh varied
significantly according to occupational status, such that the effect of sex was
dependent upon occupation. These effects were statistically significant during
the period of natural disaster but became insignificant as local conditions
improved. This demonstrates both temporal and socio-economic variation in gender
inequalities in health.
PIP: During February 1989-June 1990 in Bangladesh, local field assistants
collected data on 1366 children 2-6 years old, attending maternal and child
health clinics operated by a nongovernmental organization, and living in 13
villages in Jamalpur District situated on the banks of the Jamuna River. The
field assistants made home visits to record child morbidity every 2 weeks and to
measure child height and weight once a month. During January-April 1989, this
area suffered from extensive food shortages due to a prolonged drought and one of
the worst floods recorded in Bangladesh. Gender bias was not apparent in farming
and trading/employee households. In landless households (i.e., fathers'
occupation was laborer), girls were significantly shorter and less heavy than
boys (p 0.001), however. During a natural disaster, fathers' occupation
significantly interacted with sex (p 0.05). Specifically, children who were both
female and living in a landless household were more likely to have poor
nutritional status than children who were female and living in a farming or
trading/employee household and children who were male and living in a landless
household. This interaction was not apparent as local conditions improved. Over
the 16 months following the natural disaster, landless girls grew significantly
more in height-for-age and weight-for-age than landless boys (p 0.001). In other
words, these girls experienced more catch-up growth than the boys. At the end of
the study, nutritional status varied only according to socioeconomic status but
not according to gender. These findings suggest that gender bias within this
population depends on changes in food availability and the rural economy. Thus,
child nutrition programs should target landless girls, who are at highest risk of
gender discrimination and malnutrition during economic adversity.
PMID: 8863018 [PubMed - indexed for MEDLINE]
131. Pediatrics. 1996 Mar;97(3):312-7.
The association between parental smoking and the diet quality of low-income
children.
Johnson RK, Wang MQ, Smith MJ, Connolly G.
Department of Nutritional Sciences, University of Vermont, Burlington, VT 05405,
USA.
OBJECTIVE: To assess the association between parental smoking and the diet
quality of children residing in low-income housholds in the United States.
MTHODS: Data from 515 low-income children (less than or equal to 185% of the
poverty line), ages 2 to 17, who participated in the 1989 and 1990 United States
Department of Agriculture Continuing Survey of Food Intakes of Individuals were
examined. Diet quality was assessed by examining the average daily amount of
nutrients consumed per 1000 kcal for protein, fiber, and 14 essential vitamins
and minerals as well as total energy, percent of energy from total fat and
saturated fat, and cholesterol and sodium intakes using the 3-day average of one
24-hour recall and 2 days of diet records. Parental smoking was categorized as
four levels (nonsmoker; 1 to 10, 11 to 20, and more than 20) on the basis of the
average number of cigarettes smoked per day by the sample child's parents.
Analysis of covariance examined differences in the children's nutrient intake
among the four smoking categories while controling for race, mother's age and
occupation, child age, and sex. RESULTS: Low-income children with parents who
smoked (n = 235) were more likely to be white (P <.001), had younger mothers (P
<.05) and were more likely to have mothers employed in blue-collar occupations (P
<.001) than children whose parents were nonsmokers (N = 280). Children whose
parents smoked more than 20 cigarettes per day had a higher level of energy from
saturated fat, and children whose parents smoked 11 to 20 cigarettes per day had
the highest cholesterol intakes in comparison with the rest of the sample.
Parental smoking was also related to total fiber intake per 1000 kcal, with
children of smokers having lower fiber intakes than children of nonsmokers.
CONCLUSIONS: On average, low-income children of smokers had a poorer diet quality
than low-income children of nonsmokers, thus increasing their future risk of
chronic disease.
PMID: 8604263 [PubMed - indexed for MEDLINE]
132. Bull N Y Acad Med. 1996 Winter;73(2):370-97.
Occupations, cigarette smoking, and lung cancer in the epidemiological follow-up
to the NHANES I and the California Occupational Mortality Study.
Leigh JP.
Department of Economics, San Jose State University, CA 95192-0114, USA.
What jobs are associated with the highest and lowest levels of cigarette use and
of lung cancer? Are there gender differences in these jobs? Two data sets-the
Epidemiological Follow-up to the National Health and Nutrition Examination Survey
(NHEFS) and the California Occupational Mortality Study (COMS) were analyzed to
answer these questions. For females, the broad occupations ranking from highest
to lowest cigarette use in the NHEFS was: transportation operators, managers,
craft workers, service workers, operatives, laborers, technicians, administrative
workers, farm owners and workers, sales workers, no occupation, and
professionals. The corresponding ranking for males was: transportation operators,
no occupation, laborers, craft workers, service workers, technicians, and
professionals. The highest-ranking jobs in the COMS were waitresses, telephone
operators, and cosmetologists for women, and water-transportation workers,
roofers, foresters and loggers for men. Teachers were especially low on all four
lists. This study could not determine whether employment within any occupation
encouraged smoking or if smokers selected certain occupations.
PMCID: PMC2359318
PMID: 8982527 [PubMed - indexed for MEDLINE]
133. Nutr Health. 1996;11(1):29-48.
Food habits of mothers and children in two regions of Oman.
Musaiger AO.
Department of Food Sciences and Nutrition, Faculty of Agricultural Sciences, UAE
University, Al-Ain, United Arab Emirates.
Several rapid assessment surveys were carried out during the period 1988-1991 to
determine the food habit of preschool children, adolescent girls and mothers in
Muscat (the capital) and southern region in Oman. Data were collected from health
centers, hospitals and households. There have been differences in dietary habits
between the people in the two regions. These differences were more evident in
breastfeeding practices, meal patterns of adolescent girls and food frequency
intake of mothers. Geographical location, occupation of inhabitants, cultural and
ethnic factors may be responsible for the variation in dietary habits between the
two regions. Several unsound food practices during pregnancy and puerperium were
reported in both regions. In general, dietary patterns of mothers and children
have changed dramatically during the past two decades. Duration of breastfeeding
has declined and infant formula as well as commercial weaning foods were
introduced at an early time of infants' lives. The trend of consumption of food
for infants, adolescent girls and mothers is in the direction of unhealthier
eating habits, as foods rich in fat, cholesterol, refined sugar and salt are
commonly consumed. This food pattern may contribute to diet-related chronic
diseases such as obesity, diabetes, hypertension, heart disease and dental
caries. A nutrition education programme to promote a healthy diet and to correct
unsound food beliefs and habits is urgently needed.
PMID: 8817582 [PubMed - indexed for MEDLINE]
134. Asia Pac Popul J. 1995 Dec;10(4):3-22.
Infant feeding practices in Viet Nam.
Truong SA, Ngo TT, Knodel J, Le H, Tran TT.
PIP: Data from the 1988 Vietnam Demographic and Health Survey and the 1994
Demographic Survey are used to determine the trends in breast feeding and
amenorrhea among ever married women of reproductive age. Life table procedures
are used to calculate monthly probabilities of weaning. Then five month moving
averages of equal weight are computed for observed monthly probabilities of
weaning. The smoothed probabilities are used to calculate the cumulative
proportion weaned at successive monthly ages. Breast feeding is universal in
Vietnam. Infants are put to the breast earlier when delivery occurs at home.
Almost all children are breast fed through the first six months, and 80% are
breast fed for a year. The median duration was 15.3 months in the 1988 survey and
15.9 months in the 1994 survey based on life table methods. Calculations based on
current status methods were slightly higher for both years. Rural women tended to
breast feed longer than urban women. Children who had mothers working in
agriculture were breast fed longer than children whose mothers had other
occupations. Socioeconomic factors did not correlate well with breast feeding
duration. Findings indicate that over 66% of breast fed infants aged under 3
months were given plain water, and over 90% of infants aged 3-5 months were given
plain water. Fresh cow's milk is not given to Vietnamese infants. Juices were
given to children aged older than 6 months. Sugar water was given to younger
infants. The introduction of supplemental liquids was more common in urban areas.
Few infants during the first few months of life were given solid or mushy foods.
But by 4 months of age, 50% of infants were given solid or mushy foods, and the
practice was more common in rural areas. The urban-rural gap closed by 6 months
of age. Over 90% of infants received solids at 9 months. It is expected that
modernization will negatively impact on breast feeding.
PMID: 12291531 [PubMed - indexed for MEDLINE]
135. J Occup Environ Med. 1995 Jun;37(6):690-6.
Effects of a low-fat, worksite intervention on blood lipids and lipoproteins.
Hartman TJ, Himes JH, McCarthy PR, Kushi LH.
Division of Epidemiology, University of Minnesota School of Public Health,
Minneapolis 55454-1015, USA.
An 8-week educational intervention focusing on low-fat eating pattern messages
was conducted among employees of the city of Phoenix, Arizona. One hundred
nineteen employees with serum cholesterols of > or = 5.2 mmol/liter who
participated in at least one of eight weekly sessions were compared with 112
nonparticipants. Multiple regression analysis indicated significant intervention
effects. For participants, total blood cholesterols decreased an average of 0.22
mmol/liter, low-density lipoproteins (LDLs) decreased an average of 0.30
mmol/liter, and triglycerides decreased an average of 1.91 mmol/liter.
High-density lipoproteins (HDLs) increased an average of 0.68 mmol/liter.
Significant effects remained after considering initial lipid status, and
variation in age, sex, occupation, ethnicity, alcohol intake, fat intake, and
BMI. These results constitute a 3.8% decrease in serum cholesterol and a 7.8%
decrease in LDLs.
PMID: 7670915 [PubMed - indexed for MEDLINE]
136. Health Transit Rev. 1995 Apr;5(1):1-20.
Social inequality and children's growth in Guatemala.
Pebley AR, Goldman N.
Office of Population Research, Princeton University, NJ 08540, USA.
This paper is an investigation of the effects of social inequality in Guatemala
on children's health and nutritional status as measured by attained height.
Guatemala remains a highly stratified and poor society. We examine the
association of land distribution, land tenure, occupation, and other aspects of
family social and economic status with children's height between the ages of
three months and 36 months, using data from a cross-sectional survey. An
important consequence of the poverty and poor living conditions of the majority
of the Guatemalan population is substantial deficits in children's growth. Our
results suggest that children's growth is affected by ethnicity, their father's
occupation, land distribution in the area where they live, and maternal
education. Substantial growth deficits are observed among children living at
altitudes above 1500 metres; we hypothesize that this is because, in Guatemala,
higher altitude is associated with land scarcity, poorer agricultural conditions,
and greater remoteness from transport networks and other public services.
PIP: Population researchers used data from the 1987 National Survey of Maternal
and Child Health, 1981 census of population and housing, and the 1979
agricultural census to examine the relationship between land distribution, land
tenure, occupation, and other characteristics of family socioeconomic status with
children's growth between the ages of 3 months to 36 months in Guatemala. 57.8%
of the children were stunted. 71.9% of the children lived in rural areas
characterized as poor and in inferior living conditions. Characteristics
influencing children's growth included ethnicity (indigenous children shorter
than ladinos), father's occupation (agriculture or unskilled occupations had a
negative effect on growth), land distribution (the smaller the farm, the greater
the deficit in height), and maternal education. Children living at altitudes
greater than 1500 meters were shorter than those living at elevations less than
1500 meters (p 0.05). Land scarcity, poorer agricultural conditions, and greater
distance from transport networks and other public services were likely
responsible for the association between altitude and growth. Indigenous
populations were more likely to live at higher elevations than ladinos, partly
because, over the last 200 years, ladinos appropriated the more productive,
accessible, and desirable lands at moderate elevations. Father's occupation, land
ownership, housing quality, possession of consumer goods, residency, and size of
farms in area accounted for about 24% of the variation in height-for-age. These
findings show that poverty and poor living conditions for most of the population
adversely affect children's growth.
PMID: 10150528 [PubMed - indexed for MEDLINE]
137. Int J Epidemiol. 1995 Feb;24(1):155-64.
Nutritional change and economic crisis in an urban Congolese community.
Cornu A, Massamba JP, Traissac P, Simondon F, Villeneuve P, Delpeuch F.
Research Unit 44, ORSTOM-LNT WHO Collaborating Centre for Nutrition, Montpellier,
France.
BACKGROUND. In 1986, the government of Congo undertook a structural adjustment
programme to cope with the economic crisis. We present the results of a study
whose objectives were to assess the evolution of nutritional status of an urban
community between 1986 and 1991 and to identify specific groups for which the
nutritional status may have worsened. METHODS. Two cross-sectional surveys were
carried out on representative samples of Brazzaville children < 6 years old: 2295
children were surveyed in 1986 and 2373 in 1991. Anthropometric assessment of
nutritional status was performed. For children, weight-for-height and
height-for-age indices were used according to WHO recommendations. Wasting and
stunting were respectively defined as indices under -2 z-scores. Body mass index
of mothers was calculated and risk of chronic energy deficiency (CED) was defined
as < 18.5 kg/m2. Socioeconomic data relative to the households were also
collected. Multivariate statistical methods were used to obtain adjusted
estimates of nutritional changes in the community. RESULTS. Data analysis led to
several converging results: increase in the percentage of low birthweight (10.2%
in 1985 versus 18.7% in 1990), increase in the percentage of CED (from 7.9% to
10.5%), and increase in the prevalence of wasting (from 2.9% to 4.2%). By
contrast, the overall prevalence of stunting decreased from 13.9% to 11.0%. After
statistical adjustment, the factors found to influence the evolution of
anthropometric status were: age of child, age of mother, schooling of mother and
household characteristics such as number of preschool children, economic level
and head of household's occupation. CONCLUSIONS. The study enables the negative
effects of the economic crisis to be quantified. Body mass index is shown to be
sensitive to economic changes. It could be recommended as a possible indicator
for monitoring the nutritional status at population level. The results also call
for a new impetus in preventive health programmes and the implementation of
nutritional surveillance activities.
PIP: In the face of an economic crisis, the government of Congo in 1986 embarked
upon a structural adjustment program. A study was later conducted to assess the
evolution of nutritional status in an urban community during 1986-1991, and to
identify specific groups for which nutritional status may have worsened. The
authors present the results of this study. 2295 children in Brazzaville younger
than 6 years of age were surveyed in 1986 and 2373 in 1991. Anthropometric
assessment of nutritional status was performed and child weight-for-height and
height-for-age indices used according to World Health Organization
recommendations. Socioeconomic data relative to the households were also
collected. Between 1985 and 1990, the degree of low birth weight increased from
10.2% to 18.7%, chronic energy deficiency from 7.9% to 10.5%, and the prevalence
of wasting from 2.9% to 4.2%. The overall prevalence of stunting, however,
decreased from 13.9% to 11.0%. After statistical adjustment, child's age,
mother's age, mother's schooling, and household characteristics such as the
number of preschool children, economic level, and head of household's occupation
were found to influence the evolution of anthropometric status. Body mass index
has therefore been shown to be sensitive to economic changes and could thus be
recommended as a possible indicator for monitoring nutritional status at the
population level. Study results also call for a new impetus in preventive health
programs and the implementation of nutritional surveillance activities.
PMID: 7797338 [PubMed - indexed for MEDLINE]
138. Nutr Health. 1995;10(3):239-53.
Infant weaning practises of some Idoma women in Makurdi, Nigeria.
Igbedioh SO, Edache A, Kaka HJ.
University of Agriculture, Makurdi, Nigeria.
The weaning practices in infants aged 4-9 months of two hundred Idoma women
resident in Makurdi were examined. A pre-tested standard questionnaire was used
to collect data from mothers who regularly visited the post-natal health clinics
in Makurdi. The results showed that better educated mothers breast fed for a
shorter time or planned to cease breast feeding after a shorter period than
mothers who had little education or no formal training. Most mothers (97%) fed
milk formula which they claimed was used to supplement breast milk and was good
for their babies. The most influential factors were the hospital and the husband.
The majority of the mothers fed pap; 73% using corn in its preparation, with 91%
of them storing such paps in flask. More than half of the mothers used a bottle
in feeding the paper or gruel to their infants while a similar proportion (65.5%)
fed legumes to their infants in addition to fruits. The implications of these
practices in comparison with other ethnic groups is discussed.
PIP: During May-September 1993, in Benue State, Nigeria, interviews were
conducted with 200 healthy Idoma mothers aged 16-43 years attending the postnatal
health clinic in the Kwararafa area of Makurdi--largely a Tiv tribe
settlement--so researchers could learn about infant weaning practices of Idoma
women. 67% of the mothers had no more than primary education, while about 60% of
the husbands had at least secondary education. Most mothers breast fed on demand
6-8 times a day for 5-15 minutes. 90% planned to cease breast feeding at 12
months. The less educated mothers, who were either self-employed or unemployed,
planned to cease breast feeding later than the more educated mothers who were in
salaried employment. 97% gave their infant milk formula. Education was associated
with milk formula use (93% of mothers with no formal education, 97% of mothers
with primary education, and 100% of mothers with secondary or higher education).
The major reasons for using milk formula were supplementation of breast milk
(43%) and claiming it is good for infants (36.5%). The leading milk formula
brands were Nan (46.3%), Cerelac (30%), and SMA (10.5%). The factors that most
influenced introduction of milk formula included hospital advice (46.5%) and
husband's advice (33%). 52.5% introduced supplementary feeding at 3-4 months.
88.5% of all mothers gave supplementary food alongside breast milk. The most
important factors influencing type of supplementary food were suitability for
infant (35.5%), high quality (21.5%), and price (19.5%). The leading type of
weaning foods were pap (50.5%), Cerelac (26.5%), and pap mixed with other food
(11%). 82% of mothers fed gruel to their infant with a feeding bottle. 65.5% also
fed legumes, vegetables, and/or fruits to their infant. The decision to feed
these foods to their infant were based on hospital advice (36%), availability in
the family menu (24%), and easy availability (18.5%). Based on these findings,
health workers should use nutrition education, advice, and demonstration to teach
appropriate and timely introduction of supplementary foods, methods of food
preparation, and use of local fruits and vegetables.
PMID: 8684733 [PubMed - indexed for MEDLINE]
139. Alcohol Alcohol. 1995 Jan;30(1):71-86.
Dangerous jobs and heavy alcohol use in two national probability samples.
Leigh JP.
Department of Economics, San Jose State University, CA 95192-0114, USA.
Samples of employed persons within the US were drawn from the National Health and
Nutrition Examination Survey II (n = 8477), and the Quality of Employment Survey
(n = 1393) to test the hypothesis that a positive association existed between
alcohol use and job hazards. Heavy total alcohol use, or beer or wine or liquor
use separately, were the dependent variables. The key independent variables
included subjects' evaluations of hazardous nature of the job and fatality rates
within occupations and industries. Models were estimated with logistic
regressions controlling for age, gender, race and other covariates. Only one
robust finding emerged: heavy beer use was found to be positively and strongly
correlated with the fatality rate within occupations. Additional correlations
between job hazards and heavy alcohol use were weak, generated large P values,
and some suggested an inverse association. The lack of robust findings for the
additional correlations may partially be explained by the associations between
job categories on the one hand and choice of beverage on the other. Blue-collar
jobs are more hazardous than white-collar jobs, on average. Persons in
blue-collar jobs were more likely to drink beer, while those in white-collar jobs
were more likely to drink wine or liquor (spirits). Separate analyses of beer,
wine and liquor appeared essential to explaining correlations between dangerous
jobs and heavy alcohol use in these data. Limitations of the study included (1)
age of the data (from the 1970s). (2) alcohol use and some job hazards were
measured by self-report, and (3) data were from only one country.
PMID: 7748279 [PubMed - indexed for MEDLINE]
140. J Epidemiol Community Health. 1994 Dec;48(6):549-54.
Antioxidant vitamins in the diet: relationships with other personal
characteristics in Finland.
Järvinen R, Knekt P, Seppänen R, Reunanen A, Heliövaara M, Maatela J, Aromaa A.
Department of Clinical Nutrition, University of Kuopio, Finland.
STUDY OBJECTIVE--The study aimed to reveal associations between dietary
antioxidant vitamins and other personal characteristics. DESIGN--Population
based, cross sectional survey. SETTING--Twenty seven rural, industrial, and
semiurban communities in six different regions of Finland. PARTICIPANTS--Subjects
included 5304 men and 4750 women aged 15 years or older, who were interviewed
about their dietary habits at the baseline study of the Finnish Mobile Clinic
Health Examination Survey, 1967-72. MAIN RESULTS--Intakes of carotenoids and
vitamins A, E, and C were estimated from dietary history interviews covering the
subjects' food consumption in the preceding year. In older age groups intakes of
all the vitamins studied were low. Occupation had a profound effect on dietary
antioxidant vitamins: intakes were highest in white collar workers and lowest in
farmers; those classified as service workers, industrial workers, or housewives
came in between. Current smoking was inversely associated with dietary
carotenoids and vitamin C, especially in men. The vitamin intakes of ex-smokers
were equal to or even slightly higher than those of never smokers. Married men
had higher intakes of carotenoids and vitamin C than men living alone. Body mass
index was not an important determinant of the intake of antioxidant vitamins.
CONCLUSIONS--The associations of dietary antioxidant vitamins with
sociodemographic characteristics and smoking were strong enough to exert a
confounding or modifying effect in studies on diet and diseases.
PMCID: PMC1060030
PMID: 7830008 [PubMed - indexed for MEDLINE]
141. Eur J Clin Nutr. 1994 Nov;48 Suppl 3:S98-108; discussion S108-9.
Body mass index and illness in rural Sarawak.
Strickland SS, Ulijaszek SJ.
London School of Hygiene & Tropical Medicine, UK.
This paper reports findings of a cross-sectional anthropometric survey of 447 men
and 564 women aged > 18 years of the Iban tribe in rural Sarawak. The percentage
of each approximately 10 year cohort with body mass index (BMI: kg/m2) < 18.5
increased progressively with age > 40 years in both sexes. BMI and arm-muscle
plus bone cross-sectional area (AMBA) were influenced significantly by reported
single symptoms in men and two concurrent symptoms in women. Sensitivity of BMI <
18.5 for identifying those reporting symptoms of illness was 21% in men and 29%
in women. Independently of illness effects, values of stature, BMI and AMBA in
men, and stature alone in women, were significantly greater in those farming
plots with the shortest time left fallow, suggesting their comparative success.
The BMI of men may reflect primarily their economic activities, while that of
women their experience of illness; the AMBA may also be a better overall index of
health than BMI in this population.
PMID: 7843165 [PubMed - indexed for MEDLINE]
142. Eur J Clin Nutr. 1994 Nov;48 Suppl 3:S155-63; discussion S164.
Body mass index values in the Cuban adult population.
Berdasco A.
Department of Human Growth and Development, J. Trigo School of Medicine,
Institute of Medical Sciences, Havana, Cuba.
An anthropometric study was carried out on 31,662 male and female adults from 20
to 60 years of age, living in Cuba's 14 provinces. Measurements were taken
utilizing the methods and equipment recommended by the UN International
Biological Programme. Weight/height, body mass index (BMI), Rohrer, Sheldon,
Ponderal and Benn indices were registered as well as their correlation with
height, weight and fat folds in order to obtain the suitable index for
nutritional evaluation. The BMI was selected as the most appropriate and its
values were recorded by sex, age, dwelling, educational level and type of
occupation. The cut-off points of 'normal' BMI values were determined. Their
range, based exclusively on anthropometric data, in general coincided with those
defined by international actuarial data. The distribution of BMI values was very
similar to that of developed countries with more overweight than underweight
individuals, particularly in females. Rural populations were lighter than those
in urban communities and had more underweight subjects. Lower educational levels
were directly related to higher percentages of chronic energy deficiency (CED) in
women; in men, there was no defined trend. On the contrary, in men CED was
slightly more related to jobs that required light effort; in women there was no
defined trend. Finally, a model of action against malnutrition is proposed.
PMID: 7843153 [PubMed - indexed for MEDLINE]
143. Eur J Clin Nutr. 1994 Nov;48 Suppl 3:S148-54.
The body mass index of Chinese adults in the 1980s.
Ge K, Weisell R, Guo X, Cheng L, Ma H, Zhai F, Popkin BM.
Institute of nutrition and Food Hygiene, Chinese Academy of Preventive Medicine,
Beijing.
Patterns and trends in the body composition of Chinese adults are studied with
data from the 1982 China Nationwide Nutrition Survey (CNS-82) and the 1989 China
Health and Nutrition Survey (CHNS-89). The CNS-82 showed rural inhabitants were
approximately 3 kg lighter than urban residents and approximately 2.2 cm shorter.
Males were heavier (55.2 +/- 7.4 vs 50.7 +/- 8.0 kg) and taller (165.3 +/- 7.3
and 153.5 +/- 6.3 cm). Using a cut-off for underweight of a body mass index (BMI:
kg/m2) < 18.5 and for obesity of > 25, 11.6% and 12.9% of the urban and rural
sample were underweight and 9.8% and 6.9% respectively were overweight. The
CHNS-89 surveyed 5138 adults aged 20-45 in eight selected provinces. The
proportion of underweight in both urban and rural samples declined slightly
(approximately 1.3%) but the proportion of obesity increased considerably (4.8%
for the urban sample and 2% for the rural one). Increased income was
significantly associated with reduced low body mass index (BMI: kg/m2) in the
urban sample while, for the rural and overall samples, the opposite was found for
obesity. Provincial patterns in energy intake were not associated with the
distribution of BMI while occupation was. In particular, government officials and
housewives were much more likely to be obese as also were subpopulation groups
consuming greater proportions of energy from animal sources. Over 80% of the
population fell in the normal BMI range (18.5-25). This may relate to the
relatively even distribution of food in China during the past several decades.
PMID: 7843152 [PubMed - indexed for MEDLINE]
144. Cent Afr J Med. 1994 Sep;40(9):250-4.
Comparison of arm circumference against standard anthropometric indices using
data from a high density town near Harare, Zimbabwe.
Siziya S, Matchaba-Hove RB.
Department of Community Medicine, University of Zimbabwe School of Medicine,
Harare.
In a limited controlled sample, the performance of the middle upper arm
circumference (MUAC) was compared to those of standard indices (weight for age,
height for age and weight for height), using 90 children aged one to four years
living in a high density town near Harare, Zimbabwe. Using a cut off point of
15,5 cm, the MUAC performed best in relation to the weight for age (sensitivity
66,7 pc (95 pc confidence interval (CI) 53,3-80,0 pc), specificity 76,2 pc (95 pc
CI 61,7-80,5 pc)) than to any other standard index. Nevertheless, this
performance was unsatisfactory because about 30 in every 100 (28,9 pc) children
would have been inaccurately identified as healthy or diseased. Although we do
not have evidence from the present study to recommend the use of the MUAC in
identifying children who are malnourished and living in similar high density
areas, the MUAC may be applicable to children living in areas of higher
prevalence of malnutrition.
PIP: In January 1993, 143 children 12-60 months old, living in a high-density
town near Harare, Zimbabwe, were weighed and had their height and middle upper
arm circumference (MUAC) measured as part of a baseline survey designed to
determine the people's education, occupation, and health. The anthropometric data
were analyzed to assess the validity of the MUAC in detecting undernutrition. The
researchers used 15.5 cm as the cut-off point for the MUAC because it had the
maximum sensitivity and specificity for malnutrition when compared to weight for
age. MUAC was age dependent in infants and children older than 4 (slope 0.36 and
0.41, respectively), while it was not dependent on age in children 1-4 (slope,
0.0096). Since the numbers for children younger than one year and those for
children older than four years were low, the researchers compared the MUAC with
standard indexes in Zimbabwe from the 90 children 1-4 years old. All the children
were of normal height, making it impossible to adequately compare MUAC with the
weight for height index. 46.7% had a low MUAC (15.5 cm), however. When compared
to the weight for age, the MUAC correctly identified 71.1% of children as being
diseased or healthy (sensitivity = 66.7%; specificity = 76.2%). When compared to
the height for age, it correctly identified 54.4% of children as being diseased
or healthy (sensitivity = 50.9%; specificity = 59%). These findings show that the
MUAC performs poorly when compared to the standard indices. Thus, the researchers
do not recommend using the MUAC in detecting undernutrition in Zimbabwean
children living in high density areas.
PMID: 7834714 [PubMed - indexed for MEDLINE]
145. Appetite. 1994 Apr;22(2):183-96.
Attitudes towards high-fat foods and their low-fat alternatives: reliability and
relationship with fat intake.
Stafleu A, de Graaf C, van Staveren WA, de Jong MA.
Department of Human Nutrition, Wageningen Agricultural University, The
Netherlands.
Score on a scale of attitude towards the consumption of five high-fat foods and
their low-fat alternatives was correlated with the energy percentage of fat in
the diet across 419 subjects. Attitudes towards low-fat alternatives were more
positive than towards high-fat foods. Mean energy percentage of fat in the diet
was 38.8% (SD 7.1). The attitude scale explained 25% of the variance in
percentage energy as fat. Test-retest reliability of the attitude scale (n = 25)
was 0.92 (95% confidence limits 0.82 and 0.97). The reproducibility of energy
percentage fat in the diet (n = 33) was 0.64 (95% confidence limits 0.38 and
0.81). Differences in attitude score were found between men and women, subjects
following a dietary treatment and those who did not, and subjects with a fat
intake according to the Dutch dietary guidelines and those who had not (p <
0.001). Fat intake (expressed as percentage of energy intake) differed between
age groups (p < 0.05), and between subjects following a special diet and those
who did not (p < 0.001). No difference in attitude score or energy percentage of
fat was found for education level, occupation level, body mass index or household
size. It is concluded that attitudes towards high-fat foods and their low-fat
alternatives are useful in understanding fat intake.
PMID: 8037443 [PubMed - indexed for MEDLINE]
146. Salud Publica Mex. 1994 Mar-Apr;36(2):161-7.
[Variables associated with breast-feeding patterns in Tijuana, Mexico]
[Article in Spanish]
Leyva-Pacheco R, Bacardi-Gascón M, Jiménez-Cruz A.
Universidad Autónoma de Baja California.
The aim of this study was to determine the prevalence of feeding patterns among
infants born in four community hospitals of the city of Tijuana, Mexico. From a
total of 1964 live births, a random sample of 236 was chosen from the clinical
files and distributed according to the total number of births in each hospital.
182 mothers from the original sample were contacted and accepted to participate
in the study: 61 in the three-month group, 60 in the six-month group, and 61 in
the twelve-month group. The most usual feeding patterns were: at three months of
age, breast milk plus formula; at six months, formula plus other foods; and, at
twelve months, fresh milk plus other foods. Three infants (1.65%) were never
breastfed; at three months of age, 43 per cent of the infants were not receiving
their mother's milk; and, at six months of age, 90 per cent were dependent on
formula and other food only. Furthermore, 20.4 per cent of the infants were
weaned before reaching their first month of age; 61.3 per cent between 30 and 119
days of age, 16.8 per cent between 120 and 209 days of age, and the rest after
209 days of age. It may be concluded that infants born in community hospitals in
Tijuana show tendencies in feeding patterns similar to those of Mexican-American
infants and those of urban regions in developing countries; that is, the
substitution of breastfeeding for formula, and early weaning.
PIP: A study of the prevalence of breast feeding and the variables associated
with early weaning was conducted among infants born in four community hospitals
in the city of Tijuana, Mexico. A random sample of 236 infants was selected from
the 1964 live births in the four hospitals in proportion to the number of births
at each hospital. 182 of the 236 mothers of selected infants were interviewed. 61
of the infants were three months old, 60 were six months old, and 61 were twelve
months old at the time of the interview. 78% of the mothers were aged 20-29 years
and 70% had 4 to 6 years of schooling. Three infants were never breast fed and
none of the 182 was exclusively breast fed at the time of the interview. 19.8% of
the total sample was exclusively breast fed for 1-30 days and 76.4% for 31-90
days. 20.4% were weaned at 1-30 days, 61.3% at 31-90 days, 16.8% at 91-180 days,
and 1.5% at 180 or more days. The most common diets were breast milk and formula
at three months, formula and other foods at six months, and fresh milk and other
foods at twelve months. 26 of the 61 mothers interviewed at three months had
weaned their infants, as had 54 of the 60 interviewed at six months and 60 of the
61 interviewed at one year. Only 35% of mothers who received nutritional advice
in the hospital weaned their babies before 120 days, while 68% who did not
receive advice weaned early. Significant differences were observed between
mothers weaning or not weaning their infants by three months in nine study
variables: maternal occupation, maternal smoking, employment during pregnancy,
domestic help in the household, timing of the first breast feeding, advice
outside the hospital, contraceptive method used, expenditures for powdered milk,
and family income.
PMID: 8073332 [PubMed - indexed for MEDLINE]
147. Eur J Clin Nutr. 1993 Sep;47(9):609-16.
Calcium intakes in individuals on diets for the management of cows' milk allergy:
a case control study.
McGowan M, Gibney MJ.
Department of Clinical Medicine, TCD Medical School, St. James' Hospital, Dublin,
Ireland.
Three hundred and twenty-three individuals with self-reported food allergy were
recruited by media advertisements. Questionnaire information was collected on all
respondents. Chocolate (57%), milk (47%), wheat (36%) and food additives (35%)
were the most frequently implicated foods. The most frequently reported symptoms
were itching (43%), skin rash (43%) and tiredness (43%). Food avoidance was the
most common form of food allergy diagnosis (33%) with only 8% of respondents
reporting food challenge in food allergy diagnosis. Self-diagnosis was reported
by 34% of respondents with 29% and 24% reporting diagnosis by a general
practitioner or a homeopath, respectively. Twenty-four per cent of respondents
'always' avoided and a further 57% 'nearly always' avoided the implicated
food(s). A group of 38 adults with self-reported 'milk allergy' was selected for
further study. Dietary assessments, using the dietary history method, were
carried out on this subgroup and on age-, sex- and occupation-matched controls.
The results of the dietary assessments revealed that the 'milk allergy' group had
significantly higher intakes of fibre, beta-carotene, vitamin C, vitamin E, iron
and folic acid (P < 0.05) and significantly lower intakes of calcium (P < 0.002)
in comparison to controls. Eighteen per cent of the group used milk alternatives.
Thirty-four per cent of the 'milk allergy' group took calcium-containing
supplements. Even after calcium supplementation, the mean calcium intake of those
who completely avoided milk was unacceptably low (441 mg/d).
PMID: 8243425 [PubMed - indexed for MEDLINE]
148. Eur J Clin Nutr. 1993 Jan;47(1):31-41.
Dietary determinants of serum beta-carotene and serum retinol.
Järvinen R, Knekt P, Seppänen R, Heinonen M, Aaran RK.
Department of Clinical Nutrition, University of Kuopio, Finland.
The relationship of major dietary carotenoids, preformed and total vitamin A, and
different foods to serum beta-carotene and serum retinol levels was studied among
224 male and 117 female adults taken from the Finnish Mobile Clinic Health
Examination Survey. Serum nutrients were analysed after 10-15 years of storage at
-20 degrees C. Dietary data were collected by a quantitative dietary history
interview method. Intakes of nutrients were calculated based on analysed data on
Finnish foods. The positive gradient between beta-carotene intake and serum
level, being highly significant in women and non-significant in men, was
concentrated in non-smokers. Other major dietary carotenoids tended to be
positively correlated with serum beta-carotene in parallel with dietary
beta-carotene. Carrot intake was the most specific single food predictor for
serum beta-carotene. Serum retinol levels were not significantly associated with
dietary variables and were not affected by current smoking. In women, serum
beta-carotene values were higher, but serum retinol levels lower, compared with
men. The results support earlier findings that smoking modifies the association
between dietary beta-carotene and serum beta-carotene, and suggest that despite
the long storage of serum samples beta-carotene determinations had some value as
a biological marker for beta-carotene in the diet.
PMID: 8422871 [PubMed - indexed for MEDLINE]
149. Nutr Health. 1993;9(1):15-23.
The diet of girls and young women at the beginning of the century.
Ariouat JF, Barker DJ.
MRC Environmental Epidemiology Unit, University of Southampton, Southampton
General Hospital.
Recent research has shown that retarded growth during fetal life and infancy is
linked to the development of cardiovascular disease (coronary heart disease and
stroke) in adult life. Maternal nutrition has an important effect on early growth
and the diets of young women may therefore influence cardiovascular disease in
the next generation. Samples of women aged 80 years and over were interviewed in
six areas of England and Wales with different cardiovascular death rates. The
women, 281 in total, were asked about their diets when they were aged 10 to 15
years. Those who grew up in areas which now have low cardiovascular mortality
tended to eat four meals a day rather than three, to live in households which had
gardens, kept hens or livestock, and to go into domestic service, where diets
were generally good. Those who grew up in areas which now have high
cardiovascular mortality tended to eat less red meat, to live in houses without
gardens, to enter industrial occupations and have higher fertility rates.
PMID: 8414270 [PubMed - indexed for MEDLINE]
150. Am J Public Health. 1992 Nov;82(11):1517-24.
Disability in occupations in a national sample.
Leigh JP, Fries JF.
Department of Medicine, Stanford University School of Medicine, Calif.
OBJECTIVES. We sought to develop lists of jobs whose members reported high and
low levels of functional disability. METHODS. Samples of women (n = 6096) and men
(n = 3653) were drawn from the National Health and Nutrition Examination Survey I
Epidemiological Follow-up. Disability was measured with a modified Stanford
Health Assessment Questionnaire. We analyzed women and men separately, and we
calculated average disability indices within longest-held occupations while
adjusting for age, age-squared, married spouse present, and education. We
minimized attrition bias with an econometric technique. RESULTS. From highest to
lowest association with disability, the female broad occupations ranking was as
follows: farming, no occupation, laborers, service, technicians, operatives,
crafts workers, transportation operators, professionals, sales workers,
administrative support, and managers. The male broad occupations ranking was as
follows: no occupation, farming, operatives, crafts workers, service,
technicians, manager, administrative support, sales, and professionals. The
highest levels of disability for women and men occurred among nonconstruction
laborers, farm workers, twisting machine operators, servants, machinery
maintenance workers, mining machine operators, and bus drivers. CONCLUSIONS. Our
results suggest that, in understanding levels of functional disability,
occupational safety and health play a larger role than is generally assumed.
PMCID: PMC1694609
PMID: 1443303 [PubMed - indexed for MEDLINE]
151. Majalah Demografi Indones. 1992 Jun;(37):1-26.
Fertility determinants in Indonesia: a sequential analysis of the proximate
determinants.
Ananta A, Lim T, Molyneaux JW, Kantner A.
PIP: Data drom the Indonesian Contraceptive Prevalence Survey in 1987 was used to
examine the extent to which socioeconomic factors affect the direct association
between proximate determinants and fertility. The Bongaarts framework was applied
to individual level data on married women who had at least on birth between 1982
and 1987. The fertility measure was the probability of having a birth in the last
12 months before the survey. Proximate determinants were breast feeding, fertile
period (non-amenorrhea), sexual exposure, and contraceptive use. Socioeconomic
variables were husband's education, wife's education, husband's occupation,
religion, urban/rural status, and region of residence. The logit regression
analysis is controlled by the age of the respondent and number of children ever
born at the time of the survey. There is a possibility that socioeconomic
variables may have a direct impact on fertility and the logit framework does not
model perfectly the true stochastic model. Thus, a regression is specified in
which the probability of experiencing a birth is regressed on both proximate
determinants and socioeconomic determinants and on socioeconomic determinants
alone. Results show that fertility is lower when the duration of breast feeding
and level of contraceptive use is higher. Fertility is higher when the length of
the fertile period and sexual exposure is higher. Education showed no significant
impact on duration of breast feeding, but when both parents' education is
considered, women's lack of education is related to having longer fertile periods
(an average of 64 months). When the wife's education is considered alone, women
with no schooling and less education have 56-44 more months of sexual exposure.
The husband's education considered alone followed the same pattern. As level of
parents' education rose, the probability of contraception increased. Women have
shorter fertile periods when husbands are farmers. Religion explains duration of
breast feeding and contraception. Urban/rural status explains variations in
breast feeding duration and fertile period length. Women on Bali and Java were
shown to have shorter fertile periods, less sexual exposure, and higher
probability of contraceptive use. All 4 proximate determinants had an effect on
fertility; most socioeconomic factors had no net effect on current fertility.
Contraceptive use had the strongest effect on limiting fertility.
PMID: 12286215 [PubMed - indexed for MEDLINE]
152. J Epidemiol Community Health. 1992 Jun;46(3):191-6.
Gender and race differences in the correlation between body mass and education in
the 1971-1975 NHANES I.
Leigh JP, Fries JF, Hubert HB.
Department of Economics, San Jose State University, CA 95192-0144.
STUDY OBJECTIVE--Differences in the correlation between body mass index and
education across four gender and race groups were investigated while
simultaneously accounting for occupation, income, marital status, and age.
DESIGN--The study used analysis of covariance techniques to calculate average
body mass and confidence intervals within education categories while
simultaneously adjusting for the covariates: age, square of age, family income,
marital status, and occupation. SETTING--Data were drawn from the US National
Health and Nutrition Examination Survey (NHANES I), 1971-1975. NHANES I is a
national probability sample designed to gather information on the
non-institutionalised US civilians, ages 1-74 years. SUBJECTS--Samples of 8211
white women, 1673 black women, 6188 white men, and 1023 black men were drawn from
the NHANES I, 1971-1975. MAIN RESULTS--Data in the female samples indicate a
strictly inverse relation between body mass and years of schooling among white
women and an inverted "U" association among black women, achieving a maximum
around 8 to 11 years of schooling. In the male samples data indicate inverted "U"
relations among both black and white men, reaching maxima between 12 and 15 years
of schooling. The sides of the "U" curve are much steeper for black than for
white men. CONCLUSIONS--The four gender/race categories display four different
body mass index and education associations. These four associations are only
slightly altered by simultaneously adjusting for two additional measures of
socioeconomic status: occupation and income.
PMCID: PMC1059548
PMID: 1645069 [PubMed - indexed for MEDLINE]
153. Am J Public Health. 1992 Jun;82(6):821-6.
Socioeconomic and behavioral correlates of body mass index in black adults: the
Pitt County Study.
Croft JB, Strogatz DS, James SA, Keenan NL, Ammerman AS, Malarcher AM, Haines PS.
Department of Epidemiology, University of North Carolina, Chapel Hill.
Comment in:
Am J Public Health. 1992 Jun;82(6):785-7.
BACKGROUND. Obesity is more prevalent among Black women than Black men, but there
is little information on the correlates of obesity in Blacks. This study
describes the relations of sociodemographic factors and health behaviors to body
mass index in a southern, Black population. METHODS. In 1988, a community
probability sample of 1784 Black adults, aged 25 to 50, was examined in Pitt
County, NC. RESULTS. More women than men were at least 20% overweight (57% vs
36%). The relation of socioeconomic status (a composite of education and
occupation) to age-adjusted body mass index level was inverse in women but not in
men. Body mass index did not differ with either current energy intake or energy
expenditure. Smokers and drinkers had lower age-adjusted levels than non-smokers
and abstainers. CONCLUSIONS. Since the excess body mass index levels associated
with low socioeconomic status in women could not be explained after controlling
for adverse health behaviors, further epidemiologic study of risk factors for
obesity in Black women is recommended.
PMCID: PMC1694167
PMID: 1585962 [PubMed - indexed for MEDLINE]
154. Cancer Causes Control. 1992 May;3(3):247-54.
A cohort study of tobacco use, diet, occupation, and lung cancer mortality.
Chow WH, Schuman LM, McLaughlin JK, Bjelke E, Gridley G, Wacholder S, Chien HT,
Blot WJ.
Epidemiology and Biostatistics Program, National Cancer Institute, Bethesda, MD
20892.
In 1966, a cohort of White males aged 35 or over, who were policy-holders with
the Lutheran Brotherhood Insurance Society (United States), completed a mail
questionnaire on tobacco use, diet, and demographic characteristics. During the
20 years of follow-up, 219 lung cancer deaths occurred. Besides the strong
relationship with cigarette smoking, we observed an effect on lung cancer risk
among current users of cigars or pipes who were nonsmokers of cigarettes
(relative risk [RR] = 3.5, 95 percent confidence interval [CI] = 1.0-12.6) or who
were past/occasional users of cigarettes (RR = 2.7, CI = 1.4-5.3). In addition,
elevated risks (from 1.5 to 2.6) of lung cancer were found among craftsmen and
laborers, with the highest risks among subjects who worked in the mining or
manufacturing industry. No association between current (as of 1966) use of beer
or hard liquor and lung cancer was observed, although past users were at elevated
risk. An inverse association between lung cancer and intake of fruits was
observed, and risks of lung cancer were lower among persons in the highest
dietary intake quintiles of vitamins A and C. Except for oranges, however, none
of the inverse associations with fruits or dietary nutrients had statistically
significant trends. The findings from this cohort study add to the evidence of an
adverse effect of cigar/pipe smoking and possibly protective effect of dietary
factors on lung cancer risk.
PMID: 1610971 [PubMed - indexed for MEDLINE]
155. Bull World Health Organ. 1992;70(5):637-43.
Determinants of child nutrition and mortality in north-west Uganda.
Vella V, Tomkins A, Borghesi A, Migliori GB, Adriko BC, Crevatin E.
UNICEF, Kampala, Uganda.
An anthropometric survey of children aged 0-59 months in north-west Uganda in
February-March 1987 indicated a high prevalence of stunting but little wasting.
Use of unprotected water supplies in the dry season, prolonged breast-feeding,
and age negatively affected nutrition; in contrast, parental education level
improved nutrition. Mortality during the 12 months following the survey was
higher among those who had low weight-for-age and weight-for-height, but children
who had low height-for-age did not have higher mortality. Weight-for-age was the
most sensitive predictor of mortality at specificities > 88%, while at lower
specificity levels weight-for-height was the most sensitive. Children whose
fathers' work was associated with the distillation of alcohol had a higher risk
of mortality than other children. The lowest mortality was among children whose
fathers were businessmen or who grew tobacco.
PIP: The most frequently suggested causes of malnutrition are as follows:
poverty, low parental education, lack of sanitation, low food intake,
malabsorption, diarrhea and other infections, poor feeding practices, family
size, short birth intervals, maternal time availability, child rearing practices,
and seasonality. The purpose of this study of 1178 children 0-59 months of age
from 30 villages in Arua District, Uganda, was to assess the nutritional status
of this population and to identify sensitive predictors of mortality and major
causes of malnutrition. Anthropometric and socioeconomic and health-related data
were obtained between February and March, 1987, on the randomly selected
population. Follow-up after a year provided mortality data on the sampled
population. The results showed that nutritional status before the first 5 months
of life was satisfactory; deterioration followed. Wasting or low
weight-for-height existed predominantly among those aged 6-24 months. Stunting
was high after 5 months. The proportion of underweight children was greater in
the 2nd year of life; improvement occurred thereafter. Mortality rates were
around 10% during the first year and declined thereafter to .5% in the 4th year.
Mortality was higher among those with low weight-for-age or weight-for-height.
The relative risk for mortality was 3 at less than -3 standard deviation (SD)
weight-for-age. For less than -2 weight-for-height the relative risk was 4.6.
Mortality was higher for children 12 months of age. Weight-for-age was the most
sensitive indicator of mortality for the percentage of survivors correctly
identified over 88%; for lower specificity weight-for-height was a more sensitive
indicator. Paternal occupation was the only household indicator related to child
mortality; i.e., high mortality was related to a father's occupation as alcohol
distributor, and low mortality, to his occupation as tobacco grower or
businessman. In the stepwise multiple regression, a father's education was
positively correlated with weight-for-age, and a mother's education, with
height-for-age. Negative influences were age, breast feeding, use of unprotected
water supplies in the dry season, skin infections, and diarrhea within 2 weeks
before the survey. Paternal education was positively associated, and skin
infections negatively association, with weight-for-height. Unrelated factors are
identified; justification of significant factors is discussed.
PMCID: PMC2393364
PMID: 1464151 [PubMed - indexed for MEDLINE]
156. Nutr Health. 1992;8(2-3):159-63.
Nutritional factors for longevity in Okinawa--present and future.
Mimura G, Murakami K, Gushiken M.
Second Department of Internal Medicine, School of Medicine, University of the
Ryukyus, Okinawa, Japan.
Several factors, such as environment and heredity, are presumed to be related to
longevity. Of these nutrition is believed to function as a regulatory factor.
Okinawa prefecture is well known as the leading area for longevity in the world.
We therefore examined present and past nutrition records together with the
background of all the 88 centenarians (18 male, 70 female) who are living in
Okinawa in 1991. Their leading occupation was agriculture, and they were in work
until the 8th decade. They took rice or potato as carbohydrate with abundant
vegetables and vegetable protein or fish protein. Although they did not take a
rich diet it was well balanced, and was assumed to be related to longevity
because of the decreased incidence of atherosclerosis; together with a good
genetic background, suggested by the accumulation of longevity in their siblings.
PMID: 1407825 [PubMed - indexed for MEDLINE]
157. Vopr Onkol. 1992;38(9):1066-73.
[Increased risk factors for the occurrence of bladder cancer]
[Article in Russian]
Zaridze DG, Nekrasova LI, Basieva TKh.
Risk factors of bladder cancer development were studied in a population-based
case-control epidemiological study performed in Moscow. Relative risk (RR)
indexes appeared to be increased in smokers (4.2) and ex-smokers (3.5) with
statistically significant trends for two most important factors such as duration
of smoking and duration of withdrawal. A pronounced although insignificant
increase in the RR indexes was established for drivers (3.0) and a slight
insignificant rise-for gas arc welding operators (1.5). The indexes were
increased in subjects with a family history of cancer. The relative risk of
cancer was significantly lower in beta-carotene consumers. A preventive effect of
polyunsaturated fatty acids and oil and margarine used for frying was
established. Risk of bladder cancer tended to increase with a rise in dietary
protein. A dose-effect type inhibition of advancement of the disease by vitamin C
was observed.
PMID: 1300819 [PubMed - indexed for MEDLINE]
158. Am J Public Health. 1991 Dec;81(12):1608-12.
Socioeconomic status and electrolyte intake in black adults: the Pitt County
Study.
Gerber AM, James SA, Ammerman AS, Keenan NL, Garrett JM, Strogatz DS, Haines PS.
Department of Epidemiology, School of Public Health, University of North
Carolina, Chapel Hill.
BACKGROUND. Although the inverse association between socioeconomic status (SES)
and blood pressure has often been observed, little is known about the
relationship between SES and dietary risk factors for elevated blood pressure.
Therefore, this study described the distribution of dietary intakes of sodium,
potassium, and calcium and examined the association between electrolyte intake
and SES among 1784 Black men and women aged 25 to 50 residing in eastern North
Carolina. METHODS. Household interviews were conducted in 1988 to obtain
information on psychosocial and dietary correlates of blood pressure. Electrolyte
intake (mg/day) was assessed using a food frequency questionnaire adapted to
reflect regional and ethnic food preferences. SES was categorized into three
levels defined by the participant's educational level and occupation. RESULTS.
After adjustment for age and energy intake, potassium and calcium intake
increased with increasing SES for both sexes. Sodium intake was high for all
groups and did not vary markedly with SES, but sodium to potassium and sodium to
calcium ratios decreased with increasing SES. In addition, high SES individuals
were more likely to believe that diet affects risk for disease and to report less
salt use at the table and less current sodium consumption than in the past.
CONCLUSION. These data indicate that nutritional beliefs as well as the
consumption of electrolytes are associated with SES in Black adults.
PMCID: PMC1405262
PMID: 1746658 [PubMed - indexed for MEDLINE]
159. Pak Dev Rev. 1991 Autumn;30(3):297-311.
Are breastfeeding patterns in Pakistan changing?
Khan Z.
PIP: Prolonged breastfeeding, apart from being beneficial to a child's health,
helps keep the birth rate low. 1 of the effects of malnutrition in developing
countries is the reduction in the period of lactation. In Pakistan, where the
birth rate is already very high and the use of contraceptives limited, any
reduction in the breastfeeding period may result in an increase in the birth
rate. This study was undertaken to find out the recent changes in the
breastfeeding pattern and their potential impact on the fertility levels in
Pakistan. The data for this study are based on 2 National Fertility Surveys, the
1975 Pakistan Fertility Survey and the 1979 Population, Labor Force, and
Migration Survey. The estimation of the mean duration of breastfeeding is based
on a measure developed by Mosley (1982), given by the formula Y-BIN. where
Y=estimate of duration of breastfeeding, B=total number of children currently
being breastfed, and N=the average number of births/month. Taking maternal age,
parity, place of residence, education, and occupation as background variables,
the findings are a follows. 1) There was a decline of about 4 months in the
average length of lactation. 2) The age of the mother is positively associated
with duration of breastfeeding. 3) Urban women have shorter periods of
breastfeeding. 4) Women working on farms have longer periods of breastfeeding. 5)
A slight increase in fertility is due to a decline in breastfeeding and a
decrease in the use of contraceptives. It is suggested that breastfeeding may be
promoted among Pakistani mothers in order to reduce the birth rate. author's
modified
PMID: 12285106 [PubMed - indexed for MEDLINE]
160. Eur J Clin Nutr. 1991 Oct;45(10):469-78.
Xerophthalmia in Ethiopia: a nationwide ophthalmological, biochemical and
anthropometric survey.
Wolde-Gebriel Z, Demeke T, West CE.
Ethiopian Nutrition Institute, Addis Ababa.
A total of 6636 children, aged from 6 months to 6 years and selected throughout
the country using a multi-staged stratified sample design, were examined for
signs of xerophthalmia. The concentrations of retinol and of beta-carotene were
measured in 742 children, including those with xerophthalmia and every twentieth
of the remaining children. Anthropometric measurements were made on 2909 of the
children. Bitot's spots were seen in 1.0% of all children, with a higher
prevalence in the pastoral (1.6%) and cropping (1.1%) agro-ecological zones than
in the zones characterized by cash crops (0.4%) and 'ensete' (false banana,
Ensete ventricosum) (0.0%). One case of corneal xerosis and 2 cases of corneal
scar were also seen. Serum retinol levels were in the 'deficient' range (less
than 0.35 mumol l-1) in 16% and 'low' (0.35-0.69 mumol l-1) in 44% of children.
Serum retinol and clinical signs did not show any correlation with occupation and
education of head of household, household size or anthropometric measurements.
More stunting than wasting was observed, with peak prevalence of these signs of
malnutrition being observed in the second year of life.
PMID: 1782918 [PubMed - indexed for MEDLINE]
161. Int J Epidemiol. 1991 Sep;20(3):663-70.
A community study of alcohol consumption and dietary habits in middle-aged
Italian women.
Toniolo P, Riboli E, Cappa AP.
Institute of Environmental Medicine, New York University Medical Center, NY
10010.
This population-based study examines whether dietary intake in middle-aged
Italian women is influenced by alcohol drinking habits. The 499 participants were
interviewed using a dietary history questionnaire designed to investigate alcohol
consumption. Mean intake of total and non-alcohol energy increased progressively
within categories of increasing alcohol consumption (less than 5, 5-19, 20-39,
40+ g/day). Mean body weight and Quetelet index (kg/m2), however, decreased with
increasing alcohol consumption. Once the disparities in energy intake were
reduced by computing intake densities, the data suggest that moderate and heavy
drinkers have dietary habits similar to those of abstainers or light drinkers.
These findings were confirmed by multiple linear regression analyses in which the
confounding effects of age, place of residence, occupation, and Quetelet index
were taken into account. Increasing alcohol consumption appeared associated only
with a modest decrease in the intake of fibre, beta-carotene, and vitamin C.
These findings do not support the hypothesis that the observed protection from
coronary artery disease among moderate drinkers is related to a chronic reduction
in the intake of carbohydrates and fat, at least in middle-aged women.
PMID: 1955250 [PubMed - indexed for MEDLINE]
162. J Occup Med. 1991 Aug;33(8):853-61.
A ranking of occupations based on the blood pressures of incumbents in the
National Health and Nutrition Examination Survey I.
Leigh JP.
Department of Economics, San Jose State University, CA 95192.
Data were drawn from a subsample of the National Health and Nutrition Examination
Survey I, 1971 to 1975, consisting of persons 25 years of age and older who
stated they were employed in one of roughly 400 US Census three-digit occupations
(n = 8130). Occupations with fewer than five persons were excluded from the
analysis. Diastolic and systolic blood pressures were calculated for each of 244
occupations, simultaneously adjusting for age, gender, and body mass in an
analysis of covariance model. A disproportionately high number of craft,
operative, laboring, and farming jobs have incumbents with higher than average
blood pressures, and a disproportionately low number of professional, managerial,
and clerical jobs have incumbents with higher than average blood pressures. Jobs
whose incumbents have especially high blood pressures include bartenders and dry
cleaning operatives. Whether jobs cause high blood pressure or persons with high
blood pressure choose those particular jobs remains unknown.
PMID: 1941279 [PubMed - indexed for MEDLINE]
163. Stud Fam Plann. 1991 Jul-Aug;22(4):255-63.
Birth spacing patterns and correlates in Shaanxi, China.
Tu P.
Institute of Population Research, Peking University, Beijing, People's Republic
of China.
This study shows that most women in Shaanxi Province, China try to have their
first birth as soon as possible after their first marriage, and that the length
of the interval between marriage and first birth is strongly correlated with the
woman's age at first marriage. The length of the second and third birth intervals
and the likelihood of going on to have a second or third birth are strongly
influenced by the sex composition of children already born, the survival time of
the child initiating the interval, the duration of breastfeeding, and the woman's
occupation. There is significant regional variation in the length of birth
intervals and in the prevalence of second and third births in Shaanxi. The
findings indicate that China's one-child policy is far from being universally
accepted in Shaanxi, including its urban areas. The persistence of many social,
economic, institutional, and cultural factors promoting high fertility poses many
obstacles to further fertility decline.
PIP: A researcher applied data from the 1985 In-Depth Fertility Survey to Cox's
hazard regression model and the actuarial life table method to determine birth
spacing patterns and their correlates in Shaanxi Province in China. In the 1970s,
China encouraged later marriage, longer birth spacing, and fewer births after
which fertility declined quickly in Shaanxi (5.5-2.9 between 1970 and 1979).
Fertility hovered around 2.6 in the 1980s, however, when China promoted the one
child policy. Newly married women tended not to use effective contraceptives in
Shaanxi so 1st birth intervals bascially depended on fecundity. In fact, the
median 1st birth interval was only 14.2 months. In addition, woman's age at 1st
marriage had a very significant effect on the length of the 1st birth interval
(p.001). Further 71.5% had a 2nd birth within 5 years of the 1st birth (50.3%
urban and 76.9% rural). The 2nd birth interval was much longer than the 1st birth
interval, however (38 months: 55.7 urban and 34.5 rural). Breast feeding played a
significant role in having a 2nd birth (p.01) and 3rd birth (p.001). Further if
the index child was a girl or if the 1st 2 children were girls, the women were
highly likely to have another child (p.001) in hopes of having a son. Women's
occupation also played a considerable role in having a 2nd or 3rd birth (p.001).
For example, an agricultural worker or housewife were 3.6 times more likely to
have a 2nd birth than nonagricultural workers. The death of the index child
significantly affected the probability of having a subsequent birth for parity 1
women (p.01) but not for those of parity 2. Regional variations in the length of
birth intervals and in occurrence of 2nd and 3rd births occurred. In conclusion,
the people of Shaanxi have not accepted the one child policy. Many social,
economic, institutional, and cultural factors which foster high fertility remain.
PMID: 1949107 [PubMed - indexed for MEDLINE]
164. Hum Biol. 1991 Jun;63(3):389-402.
Sociodemographic correlates of breast feeding in Ghana.
Oheneba-Sakyi Y, Takyi BK.
Department of Sociology, State University of New York, Potsdam 13676.
This study utilizes data from the Ghana Fertility Survey (GFS) (1979-1980) to
investigate breast feeding in Ghana and the factors that affect it. Using life
table procedures, we found evidence that, when other factors are held constant,
older cohorts, women with no schooling, those who work in the agricultural
sector, those affiliated with traditional Ghanaian religions, Mole-Dagbanis,
rural residents, residents of the Volta, Brong-Ahafo, northern, and upper
regions, and low-parity women show longer durations of breast feeding. It is
recommended that, along with other fertility reduction measures, prolonged breast
feeding among all Ghanaian mothers should be encouraged to help reduce conception
and to ensure healthy children.
PIP: Data from the Ghana Fertility Survey (GFS), 1978-80, is used to investigate
the fertility levels and breast feeding behavior in Ghana. The stratified sample
of 6125 women aged 15-49 years represents region and urban, large urban and rural
sectors, of which a subsample of 4943 ever married women provides data of the
last births within the preceding 5 years. Analysis is based on survival table
procedures and accelerated failure time models to estimate the probability of
breast feeding at various ages. The Weibull regression version of general
accelerated failure time models was employed in estimating the effects of the
independent variables on the median duration of breast feeding for selected
maternal characteristics. The SAS statistical procedure, LIFEREG, was used to
estimate maximum likelihood parameters with a Newton-Raphson algorithm. The
dependent variable was the cumulative probability of breast feeding for children
who were still breast feeding, those discontinuing, and those breast fed until
their death. Independent variables were birth cohort (1930-39, 1940-49, 1950-54,
and 1955-64), age at first marriage, formal education, occupation, religion,
ethnicity, monogamous or polygynous marriage, residence, ratio of desired
children to living ones, and parity. The results show that the median duration
exceeds 12 months which is strongly related to birth cohort, .01 level of
significance. Duration decreases over time. The youngest age cohort may perceive
their breasts to be sex symbols and infant feeding formulas have become more
available. Age at first marriage has little effect on duration, but increasing
age at marriage shows a slight reduction in duration with controls operating.
Babies are breast fed longer by less educated mothers, although the multivariate
analysis indicated insignificance. Working mothers may have a conflict with
breast feeding, but professional women have about the same duration as other
women, perhaps due to the 3-month paid maternity leave. Agricultural workers tend
to breast feed longer. Only traditional believers breast feed longer, longer by
Christians by 4 months and by Muslims 2 months. Only the Mole-Dagbanis breast fed
over 1.5 years. Women in polygynous marriages also breast feed longer. Urban
women tended to have shorter durations, .05 significance level. Regional
differences varied between 14-19 months. Women from Brong-Ahafo and Volta regions
may breast feed longer because of inadequate health services. Greater parity is
associated with shorter duration. The recommendation is that contraceptives be
associated with shorter duration. The recommendation is that contraceptives be
made more widely available because of the trend in shorter feeding and
concomitantly shorter birth intervals, and that breast feeding be promoted.
PMID: 2055593 [PubMed - indexed for MEDLINE]
165. Am J Epidemiol. 1991 Apr 15;133(8):810-7.
The assessment of alcohol consumption by a simple self-administered
questionnaire.
Giovannucci E, Colditz G, Stampfer MJ, Rimm EB, Litin L, Sampson L, Willett WC.
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital,
Boston, MA.
The authors evaluated the reproducibility and validity of alcohol consumption
measured by a mailed, self-administered questionnaire in two large prospective
studies. Subsamples of 173 women and 136 men from these cohorts completed two
food-frequency questionnaires and multiple 1-week diet records (four for women
and two for men) and provided a fasting blood sample. Intakes of alcohol reported
over the previous year by food frequency questionnaire 2 correlated highly with
intake assessed by multiple week diet records completed over this period
(Spearman r = 0.90 in women and 0.86 in men). Mean daily alcohol intake as
assessed by the diet records and the questionnaires was very similar. Serum high
density lipoprotein cholesterol levels were significantly correlated with alcohol
intakes estimated from the questionnaire (r = 0.40 in women and 0.35 in men) and
for the diet records (r = 0.33 in women and 0.38 in men). Four years after
completing the diet records, women were asked to report their alcohol intake of 4
years earlier; this estimate was highly correlated with the diet records (r =
0.84) and with the earlier high density lipoprotein cholesterol (r = 0.40). These
data suggest that a simple self-administered questionnaire can provide useful
estimates of alcohol intake over an extended period of time in subjects
participating in prospective epidemiologic studies.
PMID: 2021148 [PubMed - indexed for MEDLINE]
166. Soc Sci Med. 1991;33(10):1141-54.
Opening the box: intrahousehold food allocation in rural Nepal.
Gittelsohn J.
Department of International Health, School of Hygiene and Public Health, Johns
Hopkins University, Baltimore, MD 21205.
The study examined intrahousehold food behavior in six villages in a rural hill
area of mid-Western Nepal. Qualitative and quantitative methodologies taken from
both anthropology and nutritional sciences were used to collect data on food
belief systems, household allocation of food resources, and the effect of these
features on diet and anthropometric status in a sample of 767 individuals in 115
households. Background data were also collected on socioeconomic status and
demographic variables such as education levels, occupation, and migration
patterns. The core methodological approach used direct structured observations of
meals to examine how food is distributed within households. The results document
a variety of mechanisms by which some individuals are favored over others through
household food distribution, including serving order, serving method, refusing to
serve foods, channeling foods and substituting low status foods for high status
foods. No differences were observed in mechanisms of food distribution or
nutrient intake between male and female children, contrary to evidence in the
literature suggesting that male children will be favored. On the other hand,
adult women were less likely to meet their nutrient requirements for energy,
beta-carotene, riboflavin, and vitamin C than men of the same age. Women's late
position in household serving order, channeling of special foods to males and
children, and lower total intake of food accounts for these findings.
PMID: 1767284 [PubMed - indexed for MEDLINE]
167. Int J Cancer. 1990 Jul 15;46(1):22-30.
Aromatic amine acetyltransferase as a marker for colorectal cancer: environmental
and demographic associations.
Wohlleb JC, Hunter CF, Blass B, Kadlubar FF, Chu DZ, Lang NP.
Section of Epidemiology, Arkansas Department of Health, Little Rock 72205.
In this pilot, case-controlled investigation of 43 colorectal and 41 control male
patients, we compared associations of colorectal cancer with the aromatic amine
acetyltransferase polymorphism, nutritional and demographic characteristics,
medical histories, industrial and occupational histories, and exposures from home
environments and personal habits. Persons with the "fast" acetylator trait were
at greater risk of colorectal cancer (odds ratio: 2.48; 95% confidence interval:
1.02, 6.03). Results that differed from previous reports were positive
associations of colorectal cancer with agricultural and manufacturing industries
and with consumption of meats prepared by smoking, curing, and barbecueing. As
expected, exercise frequency, cruciferous vegetables, and dietary fiber served as
protective factors.
PMID: 2365498 [PubMed - indexed for MEDLINE]
168. J Hypertens. 1990 Jul;8(7):679-85.
The effect of work environments on blood pressure: evidence from seven New York
organizations.
Schlussel YR, Schnall PL, Zimbler M, Warren K, Pickering TG.
Cardiovascular Center, New York Hospital-Cornell University Medical Center, NY
10021.
The prevalence of hypertension defined according to National Health and Nutrition
Examination Survey II (NHANES II) criteria (140/90 mmHg and/or taking
antihypertensive medication) was analyzed cross-sectionally at seven worksites in
New York City (n = 4274; 2616 men and 1648 women), in order to assess whether
exposure to different work environments and occupations contributes to blood
pressure variation. The prevalence of hypertension across worksites was 26% among
men and 12% among women. Blood pressure was significantly different across
worksites even after controlling for known risk factors using analysis of
covariance. Of the variation in systolic pressure, 34% was predicted
significantly by eight variables; after adjusting for upper-arm circumference,
age and body mass index, higher pressures were associated with worksite
differences (9.0 mmHg), being male (7.2 mmHg), lacking a high-school education
(4.3 mmHg), having a clerical occupation (2.9 mmHg) and being unmarried (1.8
mmHg). Similar results for diastolic pressure suggest that researchers should
consider worksite and job characteristics as important predictors of blood
pressure differences in working populations.
PMID: 2168459 [PubMed - indexed for MEDLINE]
169. Asia Pac Popul J. 1990 Mar;5(1):89-112.
Initiation and duration of breast-feeding in Indonesia.
Iskandar MB, Costello C, Nasution Y.
PIP: In Indonesia, nearly all women begin breastfeeding (BF); less than 4% of
children are not breast fed. The median duration of BF is 17.3 months in urban
areas, and 23.1 months in rural areas. An analysis of factors influencing the
start and length of BF, based on data from the National Indonesia Contraceptive
Prevalence Survey, reveals the importance of practices surrounding a traditional
delivery on the continuation of BF. In Java, Bali, and Outer Islands I, women who
deliver attended by a traditional birth attendant or who deliver at home are more
likely to continue BF than women having a more "modern" delivery. Children born
to a woman of higher age or parity are more likely to continue to be breast fed
into the 2nd year. Factors measuring economic status and educational levels of
parents are also inversely related to duration, but effects are less consistent
across areas. Even though BF is widespread, and lasts a long time, the benefits
of reduced morbidity and mortality, and delayed fertility that could be gained
from BF, are probably diminished owing to practices of early feeding of children.
The 1987 National Indonesia Contraceptive Prevalence Survey is a 5-year follow-up
to the 1976 World Fertility Survey and the 1983 Contraceptive Prevalence Study.
The survey covered 20 provinces out of the 27 in Indonesia, excluding less than
7% of the total population. 2 questionnaires were used; household, and individual
questionnaires. The impact of 12 independent variables on the start and length of
BF is analyzed. 1) household economic level; 2) language; 3) place of delivery;
4) type of birth attendant; 5) mother's education; 6) mother's occupational
experience; 7) spouse's education; 8) spouse's occupation; 9) mother's age at the
time of birth; 10) parity; 11) child's sex; and 12) "wantedness" of pregnancy.
Over 85% of urban children are born into high socioeconomic level households
compared to 50% in rural areas. 35 to 40% of urban mothers and nearly 50% or more
of urban spouses finish junior high school or a higher educational level.
Approximately 10% of mothers and 20% of spouses in rural areas finish a junior
high school educational level. Use of the national language (as opposed to local
languages) is more frequent in urban areas. Nearly all infants born in the
country are breast fed. author's modified
PMID: 12283352 [PubMed - indexed for MEDLINE]
170. Int J Cancer. 1989 Jun 15;43(6):1007-16.
Colorectal cancer and diet in an Asian population--a case-control study among
Singapore Chinese.
Lee HP, Gourley L, Duffy SW, Estève J, Lee J, Day NE.
Department of Community, Occupational and Family Medicine, National University of
Singapore.
A hospital-based case-control study of diet and colorectal cancer was conducted
among Chinese in Singapore (who constitute 77% of the population). A total of 203
cases and 425 controls were included. A history of the usual dietary intake one
year prior to interview was taken using a quantitative food frequency
questionnaire. Daily intakes of nutrients and selected food items were computed
and stratified by tertiles of the control range, to assess risk in low-, medium-
and high-intake categories. Effects were adjusted in analysis for age, sex,
Chinese dialect group and occupation. For cancers of colon and rectum combined,
significant observations were a protective effect of high cruciferous vegetable
intake (OR = 0.50, p less than 0.01) and a predisposing effect of a high
meat/vegetable consumption ratio (OR = 1.77, p less than 0.05). Similar results
were observed for colon cancer alone. For rectal cancer alone (only 71 cases),
significant (p less than 0.05) protective effects were observed for high intakes
of protein (OR = 0.61), fibre (OR = 0.46), beta-carotene (OR = 0.54), cruciferous
vegetables (OR = 0.51) and total vegetables (OR = 0.51). When further assessed by
multiple logistic regression, tests for trend and assessment of risk in the
extreme highest and lowest quintiles of the control range, the factors
consistently significant were cruciferous vegetable intake and the meat/vegetable
ratio. A particularly high relative risk was also noted in association with low
coffee consumption (OR = 1.59, with p less than 0.05 for trend). No consistent
trends were noted for fat or fibre intakes. For non-dietary variables
investigated, a history of cholecystectomy increased the risk of both cancers
combined (OR = 3.43, p less than 0.05) and colon cancer alone (OR = 4.39, p less
than 0.01). This study in an Asian population of countries of Southern and
Eastern Asia newly undergoing industrialization and in which rapid economic
change is reflected in changing cancer patterns, suggests that the protective
effects of certain dietary constituents, notably the cruciferous vegetables, may
be more important than the hitherto stressed carcinogenic potential of fat and
protein.
PMID: 2731998 [PubMed - indexed for MEDLINE]
171. Am J Epidemiol. 1989 Mar;129(3):483-94.
The relation of psychosocial dimensions of work with coronary heart disease risk
factors: a meta-analysis of five United States data bases.
Pieper C, LaCroix AZ, Karasek RA.
Div. of Biostatistics, Columbia U. School of Public Health, New York, NY 10032.
The relation of job psychologic demands and decision latitude to four coronary
heart disease risk factors (cholesterol, smoking, and systolic and diastolic
blood pressures) was tested among 12,555 men in five investigations conducted in
the United States during the period 1959-1980 (National Health and Nutrition
Examination Surveys I and II, National Health Examination Survey, Western
Collaborative Group Study, and Exercise Heart Survey). Using an imputation
strategy, the authors attached measures of the two job characteristics above to
persons in each data base by occupation. In 19 possible tests, decision latitude
was related (p less than 0.05) to cholesterol and smoking in two instances in the
predicted direction in the Exercise Heart Survey, when controlling for Type I
error rate. Psychologic demands were not related to any of the risk factors. When
a meta-analysis was performed across data bases, all relations were in the
predicted direction except for the relation of psychologic demands to systolic
pressure, and two of these were statistically significant (p less than 0.05): the
relation of job decision latitude to smoking and to systolic pressure. The
interaction of psychologic demands and decision latitude was not related to any
of the risk factors when two common forms of an interaction were tested. These
results indicate that psychosocial aspects of work, in particular the decision
latitude of the job, may be related to some cardiovascular risk factors.
PMID: 2916541 [PubMed - indexed for MEDLINE]
172. Food Policy. 1989 Feb;14(1):58-66.
Socioeconomic impacts of school feeding programmes: empirical evidence from a
South Indian village.
Babu SC, Hallam JA.
PIP: Tamil Nadu a poverty-stricken rural community in South India, funds a school
feeding program with about 10% of the state budget. Comparisons of nutrition and
literacy show that they are significantly related. No studies have yet been
performed to analyse the effect of the feeding programs on aspects of a
household's economic and social welfare. The feeding program in Tamil Nadu
extends throughout the year, 7 days a week. It provides not only a reason for
children to attend school, but also employment opportunities for those who wish
to cook. 455 households were surveyed from 1 village using. A Gini coefficient of
inequality to determine inequality levels of nutrition, food, and consumption
expenditure. Sen's index of poverty was used to calculate the reduction in
poverty levels. 3 household groups were defined: the agricultural labor, the silk
weaver, and the cultivator. Linear program modelling utilized these 3 groups to
study the total effect of nutrition on education. Linear regression was then used
to determine the effect of the feeding program on participation in school. At the
village level, a reduction of inequality in consumption and intake, an increase
in energy intake, and a decrease in poverty level were found. In agricultural
labor and silk weaver households, most of the money was spent on cereal food
grains and children were mostly uneducated. If modelled to assume that children
must be educated and are educated in schools providing food, results suggest that
the increase in nutrition helps retain the children in the schools. Cultivator
household response to the food programs was poor, since they usually have enough
money to meet nutritional needs. Household income and school nutrition, but not
adult literacy affect school participation. In general, nutrition offered in
school caused a subsequent increase in household purchases of non-cereal items in
the first 2 household types.
PMID: 12281938 [PubMed - indexed for MEDLINE]
173. Am J Ind Med. 1989;16(5):477-84.
Relationship of mortality, occupation, and pulmonary diffusing capacity to
pleural thickening in the First National Health and Nutrition Examination Survey.
Loomis DP, Collman GW, Rogan WJ.
Epidemiology Branch, National Institute of Environmental Health Sciences,
Research Triangle Park, NC 27709.
We studied the relationship of pleural thickening consistent with asbestos
exposure to mortality, career employment in asbestos-related jobs, and pulmonary
diffusing capacity among participants in the first National Health and Nutrition
Examination Survey. Three "B" readers examined chest X-rays to identify 59
individuals with such pleural abnormalities. From 1975 to 1984, the all-cause
mortality rate ratio (RR) comparing males with and without occupational pleural
thickening was 1.3 (95% C.I. 0.8-2.2). For lung cancer, the mortality RR for
males was 3.0 (95% C.I. 1.0-9.1). Career asbestos work was not associated with
occupational pleural thickening among men, probably because some with the
condition had only short-term exposure to asbestos. Pulmonary diffusing capacity
was lower in those with occupational pleural thickening, taking smoking into
account. These results suggest that individuals in the general population who
have occupational pleural thickening are at risk for some of the health
consequences of asbestos work, including lung cancer, even if they were not
career asbestos workers.
PMID: 2589326 [PubMed - indexed for MEDLINE]
174. Prev Med. 1988 Nov;17(6):725-35.
Determinants of serum alpha-tocopherol in Finnish adults.
Knekt P, Seppänen R, Aaran RK.
Research Institute Social Security, Helsinki, Finland.
The relationship between serum alpha-tocopherol level and many of its possible
determinants was studied in 1,373 cancer-free Finnish men and women age 40-79
years. Dietary data were available from a subsample of 301 persons. The mean
alpha-tocopherol level in the serum samples stored at -20 degrees C was 8.6
mg/liter among men and 10.5 mg/liter among women. Intake of margarine, vegetable
oils, and green vegetables predicted the serum level of alpha-tocopherol.
Altogether six food groups accounted for about 10% of the variation. The levels
also varied with age, geographical area, type of population, occupation,
socioeconomic status, and marital status. They were positively correlated with
serum cholesterol and serum vitamin A in both sexes, and with body mass index and
serum selenium in men. Altogether these variables accounted for over 40% of the
variation in alpha-tocopherol levels. The level of serum alpha-tocopherol, which
is associated with the dietary intake of vitamin E, is dependent upon living
conditions.
PMID: 3244671 [PubMed - indexed for MEDLINE]
175. Am J Public Health. 1988 Aug;78(8):910-8.
Job characteristics in relation to the prevalence of myocardial infarction in the
US Health Examination Survey (HES) and the Health and Nutrition Examination
Survey (HANES).
Karasek RA, Theorell T, Schwartz JE, Schnall PL, Pieper CF, Michela JL.
Department of Industrial and Systems Engineering, University of Southern
California, Los Angeles 90089-0193.
Associations between psychosocial job characteristics and past myocardial
infarction (MI) prevalence for employed males were tested with the Health
Examination Survey (HES) 1960-61, N = 2,409, and the Health and Nutrition
Examination Survey (HANES) 1971-75, N = 2,424. A new estimation method is used
which imputes to census occupation codes, job characteristic information from
national surveys of job characteristics (US Department of Labor, Quality of
Employment Surveys). Controlling for age, we find that employed males with jobs
which are simultaneously low in decision latitude and high in psychological work
load (a multiplicative product term isolating 20 per cent of the population) have
a higher prevalence of myocardial infarction in both data bases. In a logistic
regression analysis, using job measures adjusted for demographic factors and
controlling for age, race, education, systolic blood pressure, serum cholesterol,
smoking (HANES only), and physical exertion, we find a low decision latitude/high
psychological demand multiplicative product term associated with MI in both data
bases. Additional multiple logistic regressions show that low decision latitude
is associated with increased prevalence of MI in both the HES and the HANES.
Psychological workload and physical exertion are significant only in the HANES.
PMCID: PMC1349850
PMID: 3389427 [PubMed - indexed for MEDLINE]
176. Am J Epidemiol. 1988 Jul;128(1):179-89.
Factors associated with osteoarthritis of the knee in the first national Health
and Nutrition Examination Survey (HANES I). Evidence for an association with
overweight, race, and physical demands of work.
Anderson JJ, Felson DT.
Boston University Multipurpose Arthritis Center, MA 02118.
The authors used data from the United States first national Health and Nutrition
Examination Survey of 1971-1975 (HANES I) to explore the cross-sectional
associations between radiographic osteoarthritis of the knee and a variety of
putative risk factors. A total of 5,193 black and white study participants aged
35-74 years, 315 of whom had x-ray-diagnosed osteoarthritis of the knee, were
available for analysis. After controlling for confounders, the authors found
significant associations of knee osteoarthritis with overweight, race, and
occupation, all of which have been suggested by smaller cross-sectional studies.
They then focused specifically on those factors. For overweight, they found a
strong association between current obesity and osteoarthritis of the knee, with a
dose-response effect not previously assessed. This association was also seen for
self-reported minimum adult weight, a proxy for long-term obesity, and was
present in persons with asymptomatic osteoarthritis of the knee. These findings
strongly suggest that obesity is causative. HANES I was the first study in which
racial differences in osteoarthritis of the knee could be assessed within the
same country. The black women who were studied had an increased risk of disease
(odds ratio (OR) = 2.12, 95% confidence interval (CI) = 1.39-3.23) after
controlling for age and weight, although the black men did not. Finally, the
authors used the US Department of Labor Dictionary of Occupational Titles to
obtain characterizations of the physical demands and knee-bending stress
associated with occupations and to study the relation between physical demands of
jobs and osteoarthritis of the knee. They found for persons aged 55-64 years an
association between knee-bending demands and osteoarthritis of the knee (men, OR
= 2.45, 95% CI = 1.21-4.97; women, OR = 3.49, 95% CI = 1.22-10.52). Since such
occupational physical demands are common, the authors conclude that they may be
associated with a substantial proportion of osteoarthritis of the knee.
PMID: 3381825 [PubMed - indexed for MEDLINE]
177. Acta Med Scand Suppl. 1988;728:169-77.
Dietary survey of the FINMONICA project in 1982.
Pietinen P, Uusitalo U, Vartiainen E, Tuomilehto J.
Department of Epidemiology, National Public Health Institute, Helsinki, Finland.
A dietary survey concerning 1348 persons aged 25-64 was carried out in connection
with the first FINMONICA risk factor survey in the three monitoring areas, North
Karelia and Kuopio in the east, and Turku-Loimaa in the south-west in 1982.
Three-day food records were used in the dietary assessment. The fat content of
the diet in men was 38-39% of energy in all areas, whereas in women it was about
36% in the east compared to 38% in the south-west. The ratio of polyunsaturated
to saturated fat of the diet was lower in the east than in the south-west in both
sexes (0.25 vs. 0.31). This seemed to be the result of higher milk and butter
consumption in the east. The regional differences in the quality of dietary fats
seemed to be the result of both different occupational structures and different
dietary habits within each occupational group, especially among women.
PMID: 3202027 [PubMed - indexed for MEDLINE]
178. Rev Epidemiol Sante Publique. 1988;36(3):177-85.
A comparative study of smoking, drinking and dietary habits in population samples
in France, Italy, Spain and Switzerland. III. Consumption of alcohol.
Péquignot G, Crosignani P, Terracini B, Ascunce N, Zubiri A, Raymond L, Estève J,
Tuyns AJ.
INSERM, Section Nutrition, Le Vésinet, France.
Individual present and life time intake of aethanol has been studied in
population samples of six areas of Italy (Torino, Varese), Spain (Navarra,
Zaragoza), Switzerland (Geneva) and France (Calvados); 2,965 men and 2,369 women
were interviewed. Abstinent men were no more than 4% except in Zaragoza (11.5%);
49 to 61% drank between 20 and 80 g. aethanol a day and 21 to 26% more than 80 g.
(36% in Navarra). Women drank much less and were more often abstinent: 50 to 94%
of them did not drink or drank less than 20 g. a day. Wine was the most commonly
consumed beverage (over 60% of total alcohol intake), except in Calvados where
cider was still largely consumed (over 30%). Such differences in drinking habits
by sex and region are of major public health importance. They do not appear in
national sales statistics which must be complemented by surveys on individuals.
PMID: 3187143 [PubMed - indexed for MEDLINE]
179. Philipp Popul J. 1987 Jan-Dec;3(1-4):62-79.
Relationship of infant mortality and community development.
Abejo SD.
PIP: A researcher applied indirect estimation techniques to data from 352 rural
villages from the 1978 Republic of the Philippines Fertility Survey to determine
if community factors affect mortality of children 5 years old. Children with the
highest mortality risks included those of the poor and least educated parents.
For example, infant and child mortality stood at 203 among mothers with no
education compared to 42 among those with at least a college education. In
addition, infant and child mortality among husbands who were farmers was 111
whereas it was 28 among husbands who worked in professional and clerical jobs.
Low cost health services and midwives were the health factors that had the
greatest effect ion the probability of survival for children 5 years old,
especially among the poor and least educated. For example, the probability of
dying fell from 123-80 among the poor and 152-79 among the least educated if a
dispensary was accessible and from 131-88 among the poor and 154-96 among the
least educated if a midwife was accessible. Furthermore, adequate nutrition,
better housing conditions, safe water, and sanitation also played a key role in
reducing the probability of death. In terms of community development, only
accessibility to a newspaper outlet the families were. On the other hand, the
presence of electricity was significant only when education of the mother,
occupation of the father, and region of residence were used as control variables.
Thus the government should expand health care services to the rural population.
Further, it should integrate health components in social and economic development
programs
PMID: 12343299 [PubMed - indexed for MEDLINE]
180. Trop Doct. 1986 Apr;16(2):82-5.
Feeding patterns of children with protein-energy malnutrition in Nigeria.
Jinadu MK, Ojofeitimi EO, Osifor EO.
PIP: Feeding patterns of 115 cases of children suffering from protein-energy
malnutrition (PEM) were investigated to determine the feeding patterns and
practices of children who succumb to PEM. The study was conducted at the Ile-Ife
University Teaching Hospital in Nigeria between December, 1978 and May, 1979. 3
main clinical symptoms associated with PEM are Kwashiorkor, marasmus, and
undernutrition. A questionnaire was given to mothers to record area of residence,
age and sex of child, occupation and education level of parents, and mothers'
feeding practices (breastfeeding, use of artificial milk, food taboos.) Tables
present data on social characteristics of parents and age and sex distribution of
malnourished children. 30.4% of mothers stopped breastfeeding before children
were 1 year old, and 69.5% stopped before 17 months. 91.3% of the children were
introduced to corn pap, a gruel made from corn, before they were 6 months, and
were fed exclusively on it until after 12 months. 83.5% of mothers believed that
meat and fish would cause intestinal worms and stomach pains, and 69.6% believed
eggs would make a child steal. Mean age of onset of Kwashiorkor was 27 months.
With appropriate nutritional health education and practical demonstrations,
parents beliefs about food might be changed, possibly by reaching families
through home visiting by community health workers.
PMID: 3094212 [PubMed - indexed for MEDLINE]
181. Urol Res. 1986;14(2):67-74.
A case-control study of dietary intake of renal stone patients. I. Preliminary
analysis.
Griffith HM, O'Shea B, Keogh B, Kevany JP.
The average daily dietary intake of 88 idiopathic renal stone cases and 88 age
and sex matched controls was assessed by history using a standardised
questionnaire. Statistical analysis was undertaken on the whole group and on male
and female subgroups, to establish if there were any significant differences
between cases and controls. There were statistically significant differences in
dietary intake between the whole group, the female cases and the control group.
Male cases showed only a significantly lower intake of thiamine compared to
controls. There was little difference between cases and controls intake of iron
or multivitamin supplements but vitamin C supplements (greater than 1 g/day) were
taken more than twice as frequently by cases than controls. These results suggest
that control dietary studies of renal stone patients without regard to their sex
may conceal many differences in dietary intake between cases and controls.
PMID: 3727217 [PubMed - indexed for MEDLINE]
182. J Natl Cancer Inst. 1985 Nov;75(5):813-21.
Occupation-related risks for colorectal cancer.
Spiegelman D, Wegman DH.
Several population data bases were used to generate hypotheses about associations
between colorectal cancer and workplace exposures. The Third National Cancer
Survey interview sample was used to select 343 male and 208 female cases and 626
male and 1,235 female cancer controls. Potential work exposures were assigned
with the use of data from the National Institute for Occupational Safety and
Health National Occupational Hazard Survey. Dietary factors were modeled from the
National Health and Nutrition Examination Survey data. Work-related stress was
considered with the use of a model based on the U.S. Department of Labor's
Quality of Employment Survey. Other risk factors included age, race, ponderosity,
and menopausal status. Logistic analysis yielded hypotheses for colon cancer risk
in males with potentially high exposure to solvents, abrasives, and fuel oil and
in those in jobs with high demand and low control (high "stress"). Hypotheses
emerged for females with potentially high exposure to dyes, solvents, and
grinding wheel dust.
PMID: 3863984 [PubMed - indexed for MEDLINE]
183. J Biosoc Sci. 1985 Oct;17(4):481-96.
Factors affecting infant and child mortality.
Adlakha AL, Suchindran CM.
PIP: This paper examines the determinants of infant and child mortality
variations in Jordan, Yemen, Egypt, and Tunisia using data from WFS surveys. The
analysis considers biological correlates of mortality--mother's age, birth order,
birth interval, and previous infant loss--and several social factors--mother's
and father's education, mother's residence, father's occupation, and mother's
work experience since marriage. The estimates for the 4 countries show large
variations in the mortality rates and an expected pattern of declining infant and
child mortality during the period of 20 years prior to the survey. Further, the
proportionate decline in child mortality in each country was generally greater
than the proportionate decline in infant mortality. A persistent pattern of
higher child mortality for females than for males is found, suggesting
preferential care and treatment of male offspring. The higher mortality risk is
found for infants born to very young and very old mothers, with short previous
birth intervals, of higher birth orders, and where the previous infant had died.
Among the socioeconomic characteristics, the education of the mother and
rural-urban residence are found to affect infant survival. In childhood, among
the demographic factors, only birth interval shows a significant effect on
mortality. The risk of child mortality decreases considerably with the increase
in the birth interval. The analysis of the effect of breastfeeding on mortality,
although based on limited information, clearly shows the beneficial effect of
breastfeeding on the infant's survival, especially during the early months of
life. For all countries, the mortality rate for the non-breastfeeders is
substantially higher than for the breastfeeders even when the effect of the other
covariates is controlled.
PMID: 4055837 [PubMed - indexed for MEDLINE]
184. Nutr Rep Int. 1985 Apr;31(4):837-48.
Infant feeding practices of urban low income group in Ibadan.
Omotola BD, Akinyele IO.
The feeding pattern of 915 children from the low income areas of Ibadan were
determined with the aid of a questionnaire administered on their mothers. All the
915 infants were breast-fed for varying periods starting from birth. About 80% of
the infants were breast-fed within 48 hours of delivery but most of the mothers
in all areas claimed to have discarded the colostrum produced in the first 24
hours postpartum. Infants not breast-fed until a few days postpartum were fed on
glucose water or herbal preparations. Culture played no significant role in
infant feeding practices.
PMID: 12340967 [PubMed - indexed for MEDLINE]
185. Hum Nutr Appl Nutr. 1985 Feb;39(1):9-18.
Footnotes to food tables: 1. Differences in nutrient intakes of dietitians as
calculated from the DHSS food tables and the fourth edition of McCance and
Widdowson's 'The composition of foods'.
Black AE, Ravenscroft C, Paul AA.
The differences in nutrient intakes as calculated by two British food composition
tables (those compiled by the Department of Health and Social Security in 1963
[DHSS] and the 4th edition of McCance and Widdowson's 'The composition of Foods'
[MW4] were examined. Intakes of 43 dietitians who kept weighed diet records every
sixth day for 3 to 12 months with 11 to 75 (mean 40) days' records per subject
were calculated from each food table and compared in a loge tranformation. Mean
per cent differences between intakes (delta x 100) were vitamin A, +23.3; vitamin
D, + 21.1; riboflavin, + 16.0;calcium, +6.3; thiamin +4.8; niacin, +3.2 (MW4
higher) and protein, -1.7; fat, -3.5; energy, -3.6; carbohydrate, -6.0; vitamin
C, -6.1; iron, -11.3; vitamin B6, -14.4 (MW4 lower). Correlation coefficients
were: nicotinic acid, 0.84; vitamin B6, 0.86; other nutrients 0.90 to 0.99; thus
differences between the two food tables in classifying individuals as high or low
consumers were small. Mean intakes compared by paired t-test were significantly
different (P less than 0.001) for all nutrients except nicotinic acid, indicating
consistent differences in the food tables when applied to foods eaten by
different individuals (nicotinic acid excepted). Mean intakes compared by
one-tailed t-test -- as if the data came from independent surveys -- were
significantly different/only for riboflavin/and vitamin/B6 (P less than 0.01),
vitamin A and iron (P less than 0.05). For these nutrients, significant
differences in intakes could be found between two surveyed populations due solely
to the use of different food tables and not to differences in foods eaten. For
the other nutrients studied, differences between the food tables were of little
practical importance. Differences were due primarily to new analytical values in
MW4 for riboflavin in milk, retinol in liver, iron in meats, vitamin B6 in many
foods, and the use of margarine fortified with vitamins A and D in recipes. Major
differences in the (high) nicotinic acid content of beer, instant coffee and
specific breakfast cereals resulted in unpredictable differences in intakes of
individuals.
PMID: 4019256 [PubMed - indexed for MEDLINE]
186. Am J Ind Med. 1985;8(4-5):451-60.
Prevalence of dermatologic disease in the United States: a review of the National
Health and Nutrition Examination Survey, 1971-1974.
Johnson ML, Roberts J.
The National Health and Nutrition Examination Survey, 1971-1974, provides the
only data on the prevalence of dermatologic disease in the United States. Details
are given about specific diagnoses, disability, disfigurement, discomfort, and
the relationship of skin change to environmental and occupational exposure.
One-third of the individuals, which extrapolates to 60 million Americans, had
dermatological problems that should have been seen at least once by a physician.
Of those, at least a third considered their skin problems to be a handicap, 10% a
handicap to employment or housework. These data provide a basis for evaluating
the effect of environment and occupation and should be of interest to those
concerned with chronic effects of mechanical injury to the skin.
PMID: 4073044 [PubMed - indexed for MEDLINE]
187. Vopr Pitan. 1984 May-Jun;(3):35-8.
[Dietary fiber content of diets of the Don Basin population]
[Article in Russian]
Artemov AA, Vankhanen VV, Kovalenko AA.
It has been demonstrated that the total content of food fibers in the daily diet
of the Donbas population diets amounts to 24.0-26.3 g (cellulose 5.9-6.7 g,
pectin 2.0-2.7 g, hemicellulose 16.1-16.9 g). Baked goods account for the major
part of hemicellulose (about 85%) and 1/3 of cellulose. Potato and vegetables
(fruit) account for half of pectin and 1/3 of cellulose. The daily requirement of
cellulose and pectin was satisfied by about 1/3, which is accounted for by a high
relative significance of refined products (about 60% of the diet caloric value).
PMID: 6089435 [PubMed - indexed for MEDLINE]
188. Bull Liaison Demogr Afr. 1984 Mar-Apr;(44):8-15.
[List of household demographic surveys conducted in Cameroon]
[Article in French]
Fotso E.
PIP: A list of data collection operations in Cameroon since 1921, with notes on
geographic coverage, implementing agency, and publications is prefaced by a
series of observations about the history and development of data gathering in
colonial days and since independence. Cameroon has undertaken a number of efforts
since independence to collect demographic data, but the administrative censuses,
sectorial surveys, and isolated data gathering operations yielded results that
varied widely from 1 project to another, from 1 administration to another, and
from 1 period to another. Only after 1950 was an attempt made by the French
administration to gain a better knowledge of Cameroon's poplation after the
German occupation through more scientific investigations. Between 1950-59, 5
censuses were carried out in 5 cities. No census of national scope was conducted
before independence, so that the new nation was uninformed of its exact
population. Shorlty after independence a population and agricultural census was
planned, along with a sample survey of national scope, but budgetary difficlites
and insecurity in the southern part of the country prevented realization of the
goal, and a series of regional inquiries were undertaken instead. Examples of
specialized surveys conducted in the late 1960s and the 1970s included a
budget-consumption survey in the city of Victoria in 1966, as sample survey in
Yaounde in 1969, an employment survey in 1971, and an agricultural census in
1972. Planning for the 1st census was again initiated in 1973, and the 1976
census was a decisive steps toward to goal outlined in 1960 by the government of
mastering data collection techniques and exploitation and analysis fo results.
After 1976, the administrative and technical structures put in place for the
census, the Central Bureau of Censuses and Surveys, and the sampling base created
for the 1976 general census were used for a series of specialized surveys,
including the National Fertility Survey of 1977-78, the National Nutrition Survey
of 1978, the Budget-Consumption Survey of 1982 which is currently at the stage of
fieldwork, and the National Employment Survey in process of preparation.
PMID: 12339839 [PubMed - indexed for MEDLINE]
189. Soc Sci Med. 1984;18(1):47-57.
'These are modern times': infant feeding practice in Peninsular Malaysia.
Manderson L.
Traditionally, Malaysian women (Malay, Indian and Chinese) breastfed their
infants as a matter of course and for an extended period of time; only elite
Chinese women might have resorted to a wet-nurse. But the introduction of
condensed and dehydrated milk in colonial Malaya from the late nineteenth
century, and the later marketing also of commercially manufactured baby foods,
led to some variation in traditional practice. Structural changes,
industrialiZation and urbanisation affected social as well as economic life, and
again these broad changes had an impact on infant feeding. Today, few women
remain unfamiliar with the wide range of infant food products sold in the most
isolated provision shops. This paper focuses on key sociological factors that
might predict the frequency and duration of breastfeeding and weaning patterns.
The data analysed below, collected during semi-structured interviews with 278
women presenting at Maternal and Child Health Clinics in Peninsular Malaysia, are
in part confusing. They suggest that the women most likely to bottle feed only or
to breast feed for a short period, and to use commercial baby foods, are young,
with one child only, who reside in urban or peri-urban areas and have a
reasonable household income. Higher educated women, and women whose husbands are
in non-traditional occupations, are also less likely to breast feed or to do so
for an extended period. But the profile of infant feeding practices is by no
means clear. One of the shortcomings of the study relates to the method of
collection of data, and highlights the need for detailed ethnographic studies to
better explore the variability and complexity of the patterns of infant feeding.
PMID: 6695200 [PubMed - indexed for MEDLINE]
190. Soc Biol. 1984 Fall-Winter;31(3-4):279-89.
A note on the determinants of breastfeeding durations in an African country.
Mott SH.
PIP: This paper utilizes data from the 1977-78 Kenya Fertility Survey, 1
component of the World Fertility Survey, to analyze the determinants of
breastfeeding durations for women 15 to 50 years old who had their last-but-1
live birth between 3 and 15 years prior to the interview. Comparisons are made
with the findings fro m the World Fertility Surveys in 8 other developing
countries in Asia and Latin America. Findings indicate that literacy, urban
residence, secondary school education, and modern employment reduce the duration
of breastfeeding in Kenya. In addition, the subgroups of women who appear to be
curtailing breastfeeding are growing in proportional size or are composed of
women may be innovators or leaders. A continuation of this pattern into the
future may increase levels of infant morbidity and mortality and, in the absence
of increased modern contraceptive practice, may increase the societal level of
fertility. The death of the infant curtails the period of breastfeeding. Although
there is a pronounced preference for male children in Kenya, this preference does
not lead to differential durations of breastfeeding by sex of child. About 10% of
Kenyan women used contraception in the last closed interval. Parity and age
explain less than 1% of the variation in duration of breastfeeding in Kenya.
Kenyan women are among the least likely to have attended secondary school, to
have worked since marriage, and to have used modern contraception. The most
traditional groups of Kenyan women, those who are Muslim or who are in polygamous
unions, breastfeed for the longest durations. The Kenya Fertility Survey suggests
that the subgroup of women with some secondary school education is growing
considerably. Kikuyu women may be regarded as innovators in many respects. In
addition to having shorter breastfeeding durations, they are the least likely to
be in polygamous unions or to want more children, and they are the most likely to
be using contraception.
PMID: 6545474 [PubMed - indexed for MEDLINE]
191. Prev Med. 1983 Mar;12(2):242-61.
Standard information on environmental exposure linked to data on cancer patients,
with a brief review of the literature.
McCrea Curnen MG, Schoenfeld ER.
A review of national resources presently available for linking cancer morbidity
and mortality data with information on environmental factors is presented.
Additional sources of data on exposure, obtained directly from the patient or
from his/her hospital record, are discussed. At the patient level, an interview
questionnaire records standardized data on residential and occupational
experiences and on a variety of life-style factors such as smoking, alcohol,
nutrition, medication, and exercise. At the hospital level, a simple model
"exposure registry" is presented which, at minimal cost, would facilitate the
collection of limited data on smoking and employment (occupation/business) from
the in-patient hospital admission form and from the medical and nursing notes in
the patient's record. Both of these instruments represent efforts toward the
development of standardized data sets on environmental and personal exposures
which would constitute valuable additions to data already collected by the
worldwide network of cancer registries.
PMID: 6878187 [PubMed - indexed for MEDLINE]
192. Isr J Med Sci. 1982 Dec;18(12):1198-209.
Nutrient intake in Jerusalem--effects of origin, social class and education.
Kaufmann NA, Kark JD, Friedlander Y, Dennis BH, McClish D, Stein Y.
The independent association of ethnic group, social class and education with
nutrient intake was studied in a sample of 1,294 adults in the Jerusalem Lipid
Research Clinic (LRC) population. By univariate analysis, intake of fat and
saturated fatty acids (SFA) was higher (P less than or equal to 0.05) in males
and females of the upper social classes (classified by the occupation of the head
of the family) than in the lower classes, while the opposite trend was found for
the consumption of carbohydrates and starch. In men, an association between
social class and the intakes of protein and other carbohydrates (i.e., other than
sucrose and starch) and the ratio of polyunsaturated fatty acids (PFA) to SFA
(P:S ratio) was also found. In both sexes, the mean intakes of SFA and other
carbohydrates were higher and that of starch lower in subjects with a higher
level of education (P less than or equal to 0.05). Education was also associated
with the consumption of protein and fat in males and with that of carbohydrates
and sucrose in females. Country of origin was related (P less than or equal to
0.05) to the intake of fat, SFA and other carbohydrates in both sexes, to that of
protein and cholesterol in males and to that of carbohydrates, sucrose and starch
in females. The P:S ratio of the diet of male subjects was also associated with
origin. Using various models of analysis of variance, it was shown that origin
was associated with nutrient intake (P less than or equal to 0.10), independent
of the effect of social class and education for protein, fat, SFA, cholesterol,
sucrose and other carbohydrates in males, and for fat, SFA, PFA and other
carbohydrates in females. The P:S ratio of the male diet was also associated with
origin. The level of education was independently related (P less than or equal to
0.10) to the intake of fat, SFA, starch and other carbohydrates in males and to
that of sucrose in females, while social class was associated independently with
carbohydrate consumption in males only. After prior adjustment for origin,
education had a stronger residual effect than did social class in males, while in
females the associations of social class and education with nutrient intake were
almost identical.
PMID: 7161051 [PubMed - indexed for MEDLINE]
193. Am J Epidemiol. 1982 Dec;116(6):981-9.
The efficacy of a population-based comparison group in cross-sectional
occupational health studies.
Schulte PA, Singal M, Stringer WT, Kominsky JR, Landrigan PJ.
The availability and the choice of appropriate comparison groups are essential
for valid occupational epidemiologic studies. Too often, however, adequate
comparison groups cannot easily be found within a workplace environment or
extracted from the general population. An evaluation of the efficacy of using a
pool of comparison subjects from the health and Nutrition Examination Survey
(HANES) was performed on data gathered by the National Institute for Occupational
Safety and Health in 1979. Comparison groups from the HANES pool were derived for
246 workers at four different commercial/industrial facilities in the Niagara
Falls, New York, area and the comparability between the groups was assessed for
several demographic, behavioural, and biomedical variables. The HANES groups
exhibited a high degree of comparability with regard to most variables, excluding
ancestry. The HANES pool may serve as a useful source of subjects to allow for
the comparison of disease rates where occupational exposure is the key
distinguishing feature between groups.
PMID: 6983296 [PubMed - indexed for MEDLINE]
194. Appetite. 1982 Sep;3(3):229-41.
Nutritional practices and food intake measurements and their relationship to
socio-economic grouping, location and their apparent nutritional adequacy in
children.
Nnanyelugo DO.
PMID: 7159074 [PubMed - indexed for MEDLINE]
195. Am J Public Health. 1982 Sep;72(9):986-91.
Characteristics of individuals with multiple behavioral risk factors for coronary
heart disease: the Netherlands.
Kok FJ, Matroos AW, van den Ban AW, Hautvast JG.
To test the hypothesis that risk factors are interrelated, the simultaneous
occurrence of smoking, inadequate nutrition, obesity, and physical inactivity was
studied in a random sample (n = 1,951) of the Dutch adult population. Although
the results did not suggest systematic clustering, the assumption of independence
of these risk factors could not be maintained. Sociodemographic and
health-related characteristics of the group with three or four risk factors were
assessed (n = 246). Comparison with a prudent life-style group (zero risk
factors, n = 387) by means by discriminant analysis indicated that the target
group included proportionally more men (odds ratio: OR = 3.3), of all ages, with
low education and occupation (OR = 3.5 and 1.7). The two groups did not differ in
awareness of cardiovascular risk factors, preventive orientation regarding
cardiovascular risk, or disease in general, and the effectiveness of health
education in modifying life-style. The target group exhibited a distorted
perception of the healthfulness of its own life-style and unfavorable attitudes
toward modifying existing smoking, eating habits, and physical activity.
PMCID: PMC1650101
PMID: 7102859 [PubMed - indexed for MEDLINE]
196. Med J Zambia. 1982 May-Jul;16(3):63-5.
A pilot study of elderly people in an urban township in Lusaka.
Watts T, Chisela J, Kabaghe C.
A random sample of 20 sections in Justin Kabwe ward was made. It was possible
only to visit the houses in twelve of these sections. There were 1,586 people in
203 houses surveyed in these sections, giving an average of 7.8 people per house.
Thirty people (1.9%) aged 55 years or older were identified and were the subjects
of a more detailed survey. Twenty-two of these subjects had been in Lusaka for
over 10 years and had come looking for work or with their husbands. There were
active links with the rural areas in only 10 cases. Only three elderly people
paid a rent, the remainder either being householder or living with their
children. Half of the respondents had no animal protein on the previous day and
four people had only had a single meal. All but one woman had various occupations
either with regular employment, selling in the market or household
responsibilities. Alcohol and tobacco consumption did not appear to be a problem.
The main health problem was a raised blood pressure in half those examined,
although a diastolic blood pressure of over 100mms of mercury was only present in
4 (14%). A further survey needs to be done on the nutritional state of the
elderly, their blood pressure, and their economic situation.
PMID: 7186721 [PubMed - indexed for MEDLINE]
197. Africa (Lond). 1982;52(4):1-14.
Marital sexual relationships and birth spacing among two Yoruba sub-groups.
Adeokun LA.
PIP: Discussion focuses on the marital sexual relationships (MSR) and the timing
of the next child among the Ekiti and Ikale subgroups of the Yoruba (Nigeria).
Contrasts in postpartum sexual practices between the 2 groups allows for
demonstration of the importance of parents' perception of their child's growth
and their observance of prohibitions on sexual intercourse during the wife's
lactation as factors shaping their decision to have another child. It is argued
that the similarity in birth spacing among the 2 groups, derived from contrasting
attitudes to postpartum abstinence, is evidence of an explicit decision on the
timing of the next child. Such a decision considers the role of the child's
growth and social development as it affects adults in the performance of their
daily social and economic routines and goes beyond an unquestioned response to
quasi-religious taboos. A questionnaire was administered in the local dialect to
535 Ekiti women and 460 Ikale women, currently married and aged 14-49 years.
Appropriately modified male questionnaires were completed for 398 and 380
husbands of eligible women in the respective locations. Due in part to
conservatism in sexual behavior and family formation, the main features of Yoruba
postpartum practices such as extended and demand breastfeeding, the taboo on
sexual intercourse during lactation, and the devotion to child welfare are
believed to, and do, occur in Ekiti. Socioeconomic development has brought many
changes, but the combination of these practices with the high infant mortality
resulting from limited access to modern health care and the lack of basic
amenities assures that children are born at substantial ages apart. The need for
the surviving child to reach a consciously determined age and/or stage of growth
and development assures the adequacy and rationality of child spacing in this age
conscious society. The Ikale are an exception to the general rule concerning
sexual abstinence during lactation. The theme of a mother's trials and concern
over her children is also valid with the Ikale. The Ikale mother supplements the
natural protection offered by postpartum amenorrhea with the use of traditional
methods of contraception, most notably the rhythm method. The crude birthrates
for the 2 groups were hardly different--54.7 in Ekiti and 54.4 in Ikale. There
was only a negligible difference in fertility rates. In both groups only
negligible proportions of women would breastfeed for less than 6 months. Only
7.4% of Ikale women would breastfeed beyond 2 years, but 12.9% of Ekiti women
were breastfeeding that long. In Ikale there was a higher awareness of the
association between extended breastfeeding and the delay in the onset of
menstruation. The main implication of this discussion is to challenge the
emphasis on lactational abstinence as the main determinant of changes in
fertility behavior. The Ikale case shows that such an assumption is not valid.
PMID: 12264950 [PubMed - indexed for MEDLINE]
198. Arch Latinoam Nutr. 1981 Dec;31(4):714-25.
[Survey of nutrition knowledge and food practices by persons in charge of the
nutrition of family groups]
[Article in Portuguese]
Corrêa Santos A, Mastrodi Salgado J.
A comprehensive survey was carried out to assess the nutrition knowledge and food
practices of 115 selected households in the city of Rio das Pedras located in the
state of São Paulo. Socioeconomic factors as education and age of the mother,
occupation of the father, income and family size were considered as the
independent variables. Food practice was considered as the food consumed during
the 24 hours before the day of the interview. It was interpreted in accordance to
an adequacy scale with 3 levels: good, regular and bad. About 53% of the sample
was in the first level. The adequacy scale was compared with the theoretical
nutrition knowledge of the housewife, such as the meaning of a balanced meal
which 87.8% of the sample did not know how to define, but 47.8% of the sample
knew how to substitute correctly 3 or more foods. Knowledge about the reasons for
including the basic foods in the family meals was the weakest. Among the
socioeconomic factors under study the family size appeared to be the one most
consistently related to adequate performance in family feeding. The effect of
income level, father's occupation and formal education of the mother were
considerably less consistent and of smaller magnitude.
PMID: 7347163 [PubMed - indexed for MEDLINE]
199. J Med Assoc Thai. 1981 Jul;64(7):324-7.
Breast feeding: observation at Ramathibodi Hospital.
Pongthai S, Sakornrattanakul P, Chaturachinda K.
PIP: Demographic distribution of breast feeding among mothers who delivered at
Ramathibodi Hospital in Bangkok, Thailand was determined. 210 mothers who
delivered and returned for 6-8 weeks postpartum checkups at Ramathibodi Hospital
during December 1975 were requested to complete questionnaires which consisted of
demographic characteristics including socioeconomic factors and feeding patterns.
Only 17.4% of the mothers indicated that they were breastfeeding; 20.9% employed
artificial feeding, and 61.7% used mixed feeding. 13.9% of the primparous mothers
opted for breastfeeding; 24% of the multiparous mothers opted for breastfeeding.
There was a significant association between parity and pattern of breastfeeding.
22% of the mothers under age 20 reported breastfeeding only, while 14.5% of the
age group 21-30 years, and 33.3% of those over 30 years breastfed their babies.
There was no association between age and breastfeeding pattern. 37.5% of those
mothers without education breastfed their infants; only 7.9% of those with level
4 education breastfed. There was a statistically significant association between
educational level and pattern of breastfeeding. 30.2% of housewives breastfed
only, but about only 10% of those who worked outside the home breastfed their
infants. There was a statistically significant association between occupation and
pattern of breastfeeding. 27.8% of those whose families earned less than 3000
baht per months indicated that they breastfed, while 18% and 6.7% of those with
3000-3999 baht per month and 4000 baht per month, respectively, breastfed. There
was a statistically significant association between family income and feeding
pattern. The incidence of breastfeeding was very low compared to other reports
from the rural area. This evidence confirms the generally accepted phenomenon
that reduction of breastfeeding is associatedwith urbanization.
PMID: 7276773 [PubMed - indexed for MEDLINE]
200. Ir Med J. 1981 Jun;74(6):166-8.
Breast feeding practice and factors related to choice of feeding method.
Connolly JA, Cullen JH, MacDonald D.
PIP: The attempt was made to determine the incidence of breast feeding and to
examine selected factors related to choice of method of feeding in a sample of
143 volunteer postpartum mothers at the National Maternity Hospital in Dublin. A
questionnaire was administered by the senior nurse on duty in each of the
postnatal units of the hospital on the 4th day following delivery. 64 of the
mothers were breast feeding on the 4th postpartum day; 79 were bottle feeding. 6
mothers had tried to breast feed but for various reasons had substituted bottle
feeding. The 2 groups of breast and bottle feeding mothers were compared. There
were no significant differences between the groups in regard to maternal age,
duration of labor, birthweight, and gestation. Parity and age both parents left
school significantly differentiated the 2 groups. The major reason for choosing
bottle feeding over breast feeding was a dislike of the idea of breast feeding
(38%), followed by bottle feeding which was regarded as more convenient (24%).
Breast feeding was significantly positively associated with neonatal jaundice
occurring within the first 4 days of life. Primiparous mothers were significantly
more likely to breast feed, and mothers with 5 or more children were more likely
to bottle feed. Mothers with 2-4 children divided evenly in regard to choice of
feeding method. Breast feeding was significantly associated with higher social
class and higher-level occupation. Early school leaving age for both parents
(before age 16) was assignificantly associated with the choice of bottle feeding.
Breast feeding mothers were home owners in 84.4% of the cases, and bottle feeding
mothers in 62.3% of the cases. The current findings are certainly an indictment
of professional and population attitudes towards breast feeding.
PMID: 7287381 [PubMed - indexed for MEDLINE]