By qbx826
背景：母亲怀孕期间营养不良可能与子女成人后的心血管疾病的高发有关，但这方面的研究尚少。目的：本研究探讨在二战荷兰大饥荒期间出生的人群冠状动脉疾病是否早发。设计：研究对象为1944-1945年荷兰大饥荒期间分别处于孕晚期、孕中期和孕早期以及孕育期间不在饥荒期的冠状动脉疾病病人160例、138例、87例和590例（50或58岁）。通过Rose问卷确定CAD发生年龄，在心电图上观察到Q波（根据Minnesota心电图分级法：1级或1－2级），或进行冠状动脉血运重建手术（血管腔内或旁路形成术）。结果：与不在荷兰大饥荒期间的冠状动脉疾病病人相比，83例在此期间出生的冠状动脉疾病病人其发病年龄早3年（47岁vs 50岁），且累计发病率高13％（性别调整后HR：1.9，95% CI：1.0，3.8），按照吸烟状况（HR：1.8），社会阶层（HR：2.0）和出生时体重（HR：2.0）调整后HR保持不变。结论：本研究发现在饥荒期间出生的个体其冠状动脉疾病易早发，表明孕早期母亲营养状况在子女冠状动脉疾病发病中发挥重要作用。动物研究表明围妊娠期的孕母营养状况与后代成年后健康状况有关，本研究结果与此一致。
出处：Am J Clin Nutr. 2006 Aug;84(2):322-7; quiz 466-7.
Early onset of coronary artery disease after prenatal exposure to the Dutch famine.
BACKGROUND: Limited evidence suggests that maternal undernutrition at the time of conception is associated with increased cardiovascular disease risk in adult offspring. OBJECTIVE: We investigated whether persons conceived during the Dutch famine of World War II had an early onset of coronary artery disease (CAD). DESIGN: We compared the age at onset and cumulative incidence of CAD between persons born as term singletons who were exposed to the 1944-1945 Dutch famine during late (n = 160), mid- (n = 138), or early (n = 87) gestation and 590 unexposed subjects at age 50 or 58 y. Age at CAD onset was defined as the age at which angina pectoris was identified (according to the Rose questionnaire), Q waves were observed on an electrocardiogram (Minnesota codes 1-1 or 1-2), or coronary revascularization was performed (by angioplasty or bypass surgery). RESULTS: Of the 83 CAD cases identified, persons conceived during the famine were 3 y younger than the unexposed persons at the time of CAD diagnosis (47 y compared with 50 y) and had a higher cumulative incidence of CAD [13%; hazard ratio (HR) adjusted for sex: 1.9; 95% CI: 1.0, 3.8] than did the unexposed persons. The HR changed little after adjustment for smoking (HR: 1.8), social class (HR: 2.0), or size at birth (HR: 2.0). CONCLUSIONS: We found an earlier onset of CAD among persons conceived during the famine, which suggests that maternal nutrition in early gestation may play a role in the onset of CAD. This finding agrees with evidence from animal experiments that identify periconceptional maternal diet as important in the offspring's adult health.
PMID: 16895878
美国医学生进行营养咨询服务的行为和态度的预测
By justzhang
背景：内科医生的营养咨询服务可以改变病人的饮食行为并且受内科医生的营养行为和态度的影响，比如营养咨询服务的相关感知性。目的：这项研究的目的在于提供关于医学生营养咨询服务的感知性.咨询频率及果类和蔬菜摄入频率的数据。方法：调查和追踪来自美国16所医学院的新生（n=2316）以及他们最后一年到临床的时期。结果：调查发现新生中大约有72%的学生进行营养咨询，显著高于同时期临床学生（61%）或他们在毕业时期时（46%）。咨询服务的感知性在他们的附属专业中已经下降（p=0.0009），然而在护理专业医师中仍然保持很高水平（p=0.5）。如果他们是女生，且消费更多的果类和蔬菜，在这些学生当中就可以显著的发现进行营养咨询服务有很高的趋势，并且相信初级预防，有私人医生鼓励疾病预防，或专业初级护理。只有19%的学生相信他们在营养咨询服务中受到广泛的锻炼，17%的毕业生经常询问他们病人的营养状况。那些消费更多果类和蔬菜的学生认为如果有健康的饮食习惯他们会更有可信性，不管是亚洲人或白人，或初级护理咨询营养的病人。医学生平均消费3份果类和蔬菜。结论：美国医学生进行营养咨询服务的趋势在医学院呈下降趋势，并且学生很少询问他们病人的营养状况。干预或许能保证改善医学生的职业营养咨询行为。
出处：Am J Clin Nutr. 2006 Sep;84(3):655-62.
Predictors of nutrition counseling behaviors and attitudes in US medical students.
BACKGROUND: Nutrition counseling by physicians can improve patients' dietary behaviors and is affected by physicians' nutrition practices and attitudes, such as the perceived relevance of nutrition counseling. OBJECTIVE: The objective was to provide data on medical students' perceived relevance of nutrition counseling, reported frequency of nutrition counseling, and frequency of fruit and vegetable intakes. DESIGN: Students (n = 2316) at 16 US medical schools were surveyed and tracked at freshmen orientation, at the time of orientation to wards, and in their senior year. RESULTS: Freshmen students were more likely (72%) to find nutrition counseling highly relevant than were students at the time of ward orientation (61%) or during their senior year (46%; P for trend = 0.0003). Those intending to subspecialize had lower and declining perceptions of counseling relevance (P for trend = 0.0009), whereas the perceived relevance of counseling by primary care specialists remained high (P for trend = 0.5). Students were significantly more likely to find nutrition counseling highly relevant if they were female, consumed more fruit and vegetables, believed in primary prevention, had personal physicians who encouraged disease prevention, or intended to specialize in primary care. Only 19% of students believed that they had been extensively trained in nutrition counseling, and 17% of seniors reported that they frequently counseled their patients about nutrition. Students who consumed more fruit and vegetables, believed that they would be more credible if they ate a healthy diet, were not Asian or white, or intended to specialize in primary care counseled patients about nutrition more frequently. Medical students consumed an average of 3.0 fruit and vegetable servings/d, which declined over time. CONCLUSIONS: The perceived relevance of nutrition counseling by US medical students declined throughout medical school, and students infrequently counseled their patients about nutrition. Interventions may be warranted to improve the professional nutritional practices of medical students.
PMID: 16960182
Association between dietary glycemic index, glycemic load, and body mass index in the Inter99 study: is underreporting a problem?
By qbx826
背景：能量摄入的漏报使得进行血糖指数（GI）和血糖负荷（GL）与体重指数（BMI）的关联研究变的困难，目前这方面的研究尚少且不明确。目的：本研究的目的是以调整全部能量摄入的各种混杂因素和剔除低能量摄入者（LER）后的效应为基础，探讨GI和GL与BMI的相关性。设计：本研究采用横断面研究设计，共纳入30-60岁的6334名研究对象。通过食物食用调查问卷进行饮食摄入的估算，以白面包作为参照计算GI和GL。按照基础代谢率（EI/BMR）对能量摄入漏报进行估算。EI/BMR < 1.14被定义为低能量摄入者，应用单因素和多因素线性回归模型检验GI和GL与的相关性。混杂因素包括性别、年龄、吸烟、体力活动、饮酒和能量摄入。所有的分析在全人群和剔除LER后的亚人群中同时进行。结果：全人群的单因素分析显示，GL与BMI呈显著负相关，而GI与BMI不存在相关性。而在进行多因素（包括能量摄入）调整后，GI和GL均与BMI呈正相关。剔除LER后，GL在所用分析中均与BMI呈正相关，而GI仅在多因素分析中与BMI呈正相关。结论：本研究表明GI和GL与BMI呈正相关，能量摄入的调整和LER的剔除对分析结果影响较大，因此，应该重视能量摄入的调整。
出处：Am J Clin Nutr. 2006 Sep;84(3):641-5.
Association between dietary glycemic index, glycemic load, and body mass index in the Inter99 study: is underreporting a problem?
BACKGROUND: The few studies examining the potential associations between glycemic index (GI), glycemic load (GL), and body mass index (BMI) have provided no clear pictures. Underreporting of energy intake may be one explanation for this. OBJECTIVE: We examined the associations between GI, GL, and BMI by focusing on the confounding factor of total energy intake and the effect of exclusion of low energy reporters (LERs). DESIGN: This was a cross-sectional study of 6334 subjects aged 30-60 y. Dietary intake was estimated from a food-frequency questionnaire. GI and GL were estimated by using white bread as the reference food. Underreporting of energy intake was assessed as reported energy intake divided by basal metabolic rate (EI/BMR); LERs were defined as those having an EI/BMR < 1.14. Univariate and multiple linear regression models were used to test for associations between GI, GL, and BMI. The confounders were sex, age, smoking, physical activity, alcohol intake, and energy intake. All analyses were conducted on 1) the entire population and 2) a subsample excluding LERs. RESULTS: In the univariate analyses of the entire population, GL was inversely associated with BMI. No association was observed for GI. After full adjustment (including energy intake), both GI and GL were positively associated with BMI. When LERs were excluded, GL was positively associated with BMI in all analyses, and GI was positively associated with BMI in the multiple analyses. CONCLUSIONS: We showed a positive association between GI, GL, and BMI. Energy adjustment and the exclusion of LERs significantly affected the results of the analysis; thus, we stress the importance of energy adjustment.
PMID: 16960180
