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As welfare providers struggle to meet the care needs of persons with dementia (PwDs), most of their needs are being met by a family carers, most often a spouse. The situation for spouse carers is unique, e.g., with grief, loneliness and loss of intimacy combining with stress and poor health. Research is needed to develop adequate support for spouse carers based on evidence of what influences negative and positive outcomes of care. The present study investigated psychosocial correlates of spouse carers’ (i) negative impact and (ii) positive value of caring. Data from a cross-sectional survey of 165 spouse carers community-resident in Sweden was analysed in two hierarchical regression models to predict negative impact and positive value of caring. Results found that negative impact and positive value were explained by different variables, significant predictors for negative impact included carer stress, health, and emotional loneliness, and change in intimacy with the care-recipient, while positive value was predicted by mutuality, change in closeness to the care-recipient and quality of support. Negative impact and positive value shared variance of only 17.2%. Thus, negative impact and positive value represent different aspects of the carer situation. Consequently, support needs to target several aspects in carers’ life, aiming to; facilitate for spouses to manage PwD’s impairment, increase emotional support while also strengthening the relationship between carer and PwD to reduce negative impact while increasing positive value.

This chapter is organized around a critique of current sexual harassment research. Its ultimate goal is to encourage researchers to develop a broader research definition of sexual harassment that can address both individual and organizational forms of sexual harassment. Many social science researchers have found the legal definition of sexual harassment vague and difficult to operationalize in part because it focuses on the subjective experience of hostility and offensiveness, and not objective behaviors. Instead, those who do not disclose any information about their sexual orientation are typically assumed to be heterosexual. Jane Gallop decries this research and policy focus as heterosexist, because it conflates sexual behavior with heterosexual behavior, and because it assumes that all male-female interactions are potentially sexual. Sexual harassment is not only perpetrated by individuals, but it is also institutionalized in organizations and in workplace culture. Co-workers are not the only source of sexual harassment; clients and customers can and often do sexually harass employees.

There is no minimum fiber requirement for on-pack whole-grain claims, yet consumers perceive products made with whole grains to provide at least a good source of fiber. To understand how this misperception may be fueling Americans’ fiber intake shortfall, this study investigated the impact on fiber intakes of ready-to-eat (RTE) cereal products with whole-grain claims. A 14-day eating frequency diary was collected from US free-living households over 3 years in the NPD Group’s National Eating Trends (NET) panel (n=10,708). Average daily fiber intake and sources were calculated from the types and frequency of food and beverages consumed at meals. T-tests were conducted on mean fiber intake at breakfast and daily to identify significant differences between all adults, adults consuming whole-grain RTE cereals with

Perspectives on Gender and Carework, guest-edited by Mary Zimmerman and Jacqueline Litt, did come to fruition during my editorial term. I also began an inter-journal exchange with the Asian Journal of Women's Studies', and abroad, I co-organized a panel of Latin American and Caribbean and U.S. based scholarly journal editors on "Promoting Collaborations Among Feminist Journals" as part of a conference on "Globalization and Gender" that was held at the University of Costa Rica in April 2003.1 also worked to revi talize our International Advisory Board. I believe my efforts worked to sensitize gender scholars to the differ ences and similarities in gender research around the globe. At least I can report that as of early 2003, Gender & Society was named a "Journal of the Century" in a book of the same name compiled by specialist librarians from many disciplines and published by Haworth Information Press. Our journal, listed under the Sociology category, was the youngest title to make the list.

Dietary Guidelines have emerged over the past 30 years recommending that Americans limit their consumption of total fat and saturated fat as one way to reduce the risk of a range of chronic diseases. However, a low-fat diet is not a no-fat diet. Dietary fat clearly serves a number of essential functions. For example, maternal energy deficiency, possible exacerbated by very low-fat intakes (< 15% of energy), is one key determinant in the etiology of low birth weight. The debate continues over recommendations for limiting total fat and saturated fatty acid intake in children. Recent evidence indicates that diets with adequate energy providing less than 30% of energy from fat are sufficient to promote normal growth and normal sexual maturation. More attention needs to be devoted to the effect of dietary fat reduction on the nutrient density of children's diets. The association between dietary fat and CHD has been extensively studied. Diets high in saturated fatty acids and trans fatty acids increase LDL cholesterol levels, and in turn, the risk of heart disease. The relationship between high-carbohydrate/low-fat diets and CHD is more ambiguous because high-carbohydrate diets induce dyslipidemia in certain individuals. Obesity among adults and children is now of epidemic proportions in the United States. High-fat diets leading to excessive energy intakes are strongly linked to the increasing obesity in the United States. However, the prevalence of obesity has increased during the same time period that dietary fat intake (both in absolute terms and as a percentage of total dietary energy) has decreased. These trends suggest that a concomitant decrease in total dietary energy and modifications of other lifestyle factors, such as physical activity, also need to be emphasized. Obesity is also an independent risk factor for the development of diabetes. The current availability of fat-modified foods offers the potential for dietary fat reduction and treatment of the comorbidities associated with diabetes. However, to date, few studies have documented the effectiveness of fat-modified foods as part of a weight loss regimen or in reduction in CHD risks among individuals with diabetes mellitus. The association between total dietary fat and cancer is still under debate. While there is some evidence demonstrating associations between dietary fat intake and cancers of the breast, prostate, and colon, there are serious methodologic issues, including the difficulty in differentiating the effects of dietary fat independent of total energy intake. Reported total fat and saturated fatty acid intakes as a percentage of total energy have been declining over the past 30 years in the United States. Despite this encouraging trend, the majority of individuals--regardless of age--do not report consuming a diet that meets the levels of fat and saturated fatty acids recommended by the Dietary Guidelines for Americans. On a relative basis, saturated fat intake has gone down less than has total fat intake. Individuals of all ages who report consuming a diet with < or = 30% of energy from fat consistently have lower energy intakes. Given the increasing rates of obesity in the United States at an earlier and earlier age, dietary fat reduction may be an effective part of an overall strategy to balance energy consumption with energy needs. In each of the age/gender groups reporting consumption of < or = 30% of energy from fat and less than 10% of energy from saturated fatty acids, fat-modified foods play a more important role in their diets than for people who are consuming higher levels of fat and saturated fat. The data are clear than fat-modified foods make a more significant contribution to diets of consumers with low-fat intakes. While one cannot argue cause and effect from the results presented, the patterns of fat-modified foods/low-fat intakes are consistent. The focus on overall diet quality is often lost in the national obsession with lowering fat inta

Cardiovascular disease (CVD) risk factors can be identified in children and tracked over time. We studied 519 children (mean age, 3.9 years) and reevaluated CVD risk factors 4 years later. Baseline and follow-up (FU) measures included height, weight, body mass index (BMI), blood pressure level, blood lipid values, and 24-hour dietary intake. Nutritional predictors of CVD risk factors (lipid levels and BMI) were identified using regression analysis at follow-up. Energy intake at baseline and FU, as well as increasing BMI over time, were directly associated with total cholesterol levels. Dietary intake of monounsaturated fat and dietary fiber were significant predictors of total cholesterol level at follow-up (inverse associations). Increasing BMI, waist circumference at FU, and intake of sucrose at FU were inversely associated with high-density lipoprotein cholesterol levels at FU. Waist circumference and BMI at FU were associated with higher triglyceride levels, while percent energy from monounsaturated fat was associated with lower values. This study provides further evidence that dietary intake influences CVD risk factors in childhood.

Dietary fiber (DF) has important health benefits in childhood, especially in promoting normal laxation. Studies also suggest that DF in childhood may be useful in preventing and treating obesity and also in lowering blood cholesterol levels, both of which may help reduce the risk of future cardiovascular disease. In adults, a high-fiber, low-fat diet has been linked to reduced rates of colon and other human cancers, and although it seems highly likely that this benefit would be even greater if this regimen had been started in childhood, epidemiologic and experimental confirmation is currently lacking. Children's typical DF consumption may not be adequate to maintain good health and prevent disease. Therefore, it would be prudent to recommend that children and adolescents increase DF intake by increasing consumption of fruits, vegetables, legumes, cereals, and other grain products. Several guidelines recommend quantitative ranges of DF intake for children. These include recommendations by the National Academy of Sciences, the Food and Drug Administration's (FDA) food label guide, and the "Age+5" guideline. The goal is to achieve a DF intake that is safe even for children and adolescents with marginal intake of vitamins and minerals, provides sufficient DF for normal laxation, and reduces the risk of future chronic diseases, such as coronary artery disease. Current estimates of DF intake are much lower than recommended levels for a large proportion of the US pediatric population. This article reviews these data.

The prevalence of overweight among children and adolescents has dramatically increased. There may be vulnerable periods for weight gain during childhood and adolescence that also offer opportunities for prevention of overweight. Overweight in children and adolescents can result in a variety of adverse health outcomes, including type 2 diabetes, obstructive sleep apnea, hypertension, dyslipidemia, and the metabolic syndrome. The best approach to this problem is prevention of abnormal weight gain. Several strategies for prevention are presented. In addition, treatment approaches are presented, including behavioral, pharmacological, and surgical treatment. Childhood and adolescent overweight is one of the most important current public health concerns.

Data on weight, height, blood pressure, and blood lipids were obtained for 1215 children entering New York Head Start preschools from 1995-1997. In this population, 17% were overweight and 15% were obese; the risk was greatest in Hispanic children. Overall, 13% had high blood pressure. African-American children were at increased risk of elevated blood pressure but had a more favorable lipid profile (high high-density lipoprotein cholesterol level and low triglycerides level) than white or Hispanic children. Body size was a significant predictor of elevated blood pressure, low high-density lipoprotein cholesterol, and increased triglycerides. The association between obesity and blood pressure was evident in white and Hispanic children only. Neither ethnicity nor obesity was associated with total cholesterol level. Obese preschoolers had approximately three times the risk of having high systolic blood pressure and twice the risk of low high-density lipoprotein cholesterol level compared with nonobese children, indicating that at-risk populations can be identified and primary prevention begun at a young age.

To evaluate the impact of a multicomponent cardiovascular health intervention ("Healthy Start") which included a food service modification in a largely minority Head Start preschool population. The primary outcome measure was the change in serum cholesterol from the beginning to the end of the school year.Nine Head Start centers in Upstate N.Y. were assigned to either food service modification or control conditions. In addition, half of the centers assigned to the food service modification received supplemental nutrition education (FS/NU--food service modification/nutritional education), while the remaining centers were provided with supplemental safety education materials (FS--food service modification only). The control preschool centers (CON) also received supplemental safety educational curricula for children but their food services remained unchanged. Children had serum cholesterol, as well as height and weight measured at the beginning and end of the school year. A generalized linear univariate procedure was used with percent change in total serum cholesterol as the outcome variable and intervention group as the primary independent variable.There was a significant decrease in total serum cholesterol among preschool children in food service intervention groups, (FS/NU and FS), compared to Controls (-6.0 versus -0.4 mg/dL). In addition to the significant difference in group means, children with elevated cholesterol at baseline were significantly more likely to have a cholesterol level in the normal range (170 mg/dL) at follow-up if they attended a preschool in the food service modification group. There was a 30% reduction in risk of elevated cholesterol in the latter compared to controls. Participation in the dietary intervention did not affect short-term growth.A preschool heart health intervention, "Healthy Start," designed to reduce the total and saturated fat content of snacks and meals to recommended levels was effective in reducing serum cholesterol in the study population as a whole and specifically children 'at risk'; i.e., those with initial elevated serum cholesterol.

Although many women experience harmful behaviors that fit the legal definition of sexual harassment, very few ever label their experiences as such. I explore how psychological ambivalence expressed as sadomasochism may account for some of this gap. Following Lynn Chancer, I argue that certain structural circumstances characteristic of highly stratified bureaucratic organizations may promote these psychological responses. After discussing two illustrations of this dynamic, I draw out the implications for sexual harassment theory and policy.

Overweight and obesity in children is epidemic in North America and internationally. Approximately 22 million children under 5 years of age are overweight across the world. In the United States, the number of overweight children and adolescents has doubled in the last two to three decades, and similar doubling rates are being observed worldwide, including in developing countries and regions where an increase in Westernization of behavioral and dietary lifestyles is evident. Comorbidities associated with obesity and overweight are similar in children as in the adult population. Elevated blood pressure, dyslipidemia, and a higher prevalence of factors associated with insulin resistance and type 2 diabetes appear as frequent comorbidities in the overweight and obese pediatric population. In some populations, type 2 diabetes is now the dominant form of diabetes in children and adolescents. Disturbingly, obesity in childhood, particularly in adolescence, is a key predictor for obesity in adulthood. Moreover, morbidity and mortality in the adult population is increased in individuals who were overweight in adolescence, even if they lose the extra weight during adulthood. Although the cause of obesity in children is similar to that of adults (i.e., more energy in vs. energy utilized), emerging data suggest associations between the influence of maternal and fetal factors during intrauterine growth and growth during the first year of life, on risk of later development of adult obesity and its comorbidities. In addition, recent data suggest that varying biological responses in different racial/ethnic groups differently contribute to overweight, obesity, and their comorbidities. Although differences in gene-nutrient interactions may contribute, the role of varying cultural and socioeconomic variables still needs to be determined to understand these disparities. Novel approaches in the prevention and treatment of childhood overweight and obesity are urgently required. With the strong evidence that a lifecycle perspective is important in obesity development and its consequences, consideration must be focused on prevention of obesity in women of child-bearing age, excessive weight gain during pregnancy, and the role of breast-feeding in reducing later obesity in children and adults. Consideration must be given to family behavior patterns, diet after weaning, and the use of new methods of information dissemination to help reduce the impact of childhood obesity worldwide.

Health care professionals use strategies during the physical examination to stay in control of their feelings, the behaviors of their patients, and to avoid allegations of sexual misconduct. To investigate how health care practitioners desexualize physical exams, the authors conducted 70 in-depth interviews with physicians and nurses. Three desexualizing strategies were general ones, used by both male and female health care providers, and were employed regardless of the characteristics of the patients: engaging in conversation and nonsexual joking, meeting the patient clothed before the exam, and using medical rather than colloquial terms. Six strategies were used only in specific contexts or were used primarily by men or women. These gendered strategies include using a chaperone, objectifying the patient, empathizing with the patient, joking about sex, threatening the patient, and looking professional. The authors conclude that desexualizing the exam is gendered and, in some contexts, (hetero) sexualized. Using certain strategies bolsters stereotypes about gender and heterosexual relationships in the hospital.

This article explores the reasons some pregnant women enter maternity homes with the plan to place their babies for adoption. The authors discuss changes in maternity homes over the twentieth century and report on findings from a survey of currently licensed homes in Texas. Next, the authors discuss the findings from fieldwork and in-depth interviews with residents of two maternity homes. They identify three major reasons why birth mothers enter maternity homes: (1) the desire to escape abusive or stressful family lives, (2) the desire to avoid the stigma of placing a child for adoption, and (3) the desire to provide their children, and in some cases themselves, with a stable and loving family life. The authors contend that entering a maternity home with the intention of placing their babies for adoption represents an effort on the part of birth mothers to reconfigure their own, often impoverished family lives.

The objective of the study was to evaluate the effects of plant stanol esters and bran fiber on lipids, stool weight and stool frequency in preschool children.The present study was a 13 week open cross-over study designed to evaluate the effects of plant stanol ester in healthy two to five year old preschool children. After a one week lead-in, eligible children were randomly assigned to begin with either Diet Phase A (plant stanol ester) or Phase B (wheat bran fiber). Each diet phase was four weeks long, followed by a two-week wash-out, and then cross-over to the alternate diet. During Diet Phase A children consumed three eight-gram servings of a spread, each containing one gram of plant stanols, for total daily dose of three grams. During Diet Phase B, children added five grams of dietary fiber to their diet for the first two weeks and then ten grams for the second two weeks.Overall, for the whole study group, plant-stanol-ester spread use yielded a decrease in total cholesterol of 19.9 mg/dL (12.4% reduction from baseline) and a 14.6 mg/dL decrease in LDL cholesterol (15.5% reduction from baseline). There were no significant changes in HDL-cholesterol or triglyceride levels. A predominately insoluble dietary fiber supplement derived from wheat bran, as expected, yielded a small but non-significant decrease in total cholesterol of 6.1 mg/dL, a four percent reduction from baseline.Results demonstrated that preschool age children could adhere to a program requiring consumption of three daily servings of spread containing plant stanol ester and that this level of consumption resulted in a significant decrease in total cholesterol and LDL cholesterol after a four week period. In addition, consumption of plant stanol ester was not associated with any short-term adverse health effects.

Diet can play a major role in cancer prevention. The international differences in cancer incidence are largely accounted for by lifestyle practices that include nutrition, exercise, and alcohol and tobacco use. About 50% of cancer incidence and 35% of cancer mortality in the U.S., represented by cancers of the breast, prostate, pancreas, ovary, endometrium, and colon, are associated with Western dietary habits. Cancer of the stomach, currently a major disease in the Far East, relates to distinct, specific nutritional elements such as excessive salt intake. For these cancers, information is available on possible initiating genotoxic factors, promoting elements, and prophylactic agents. In general, the typical diet in the United States contains low levels of the potent carcinogenic agents, heterocyclic amines, formed during the cooking of meats. It provides only about half the potent appropriate fiber intake and is high in calories. About twice as many calories as would be desirable come from fat, certain kinds of which enhance the development of cancers. Other foods with functional properties, such as soy products and tea, can be beneficial. To achieve reduction in risk of certain cancers, diet must be optimized, primarily to reduce caloric intake and the fat component. The latter should be 20% or less of total caloric intake and fiber should be increased to 25-35 g per day for adults. One approach to achieving these goals is the Fiber First Diet, a diet designed around adequate fiber intake from grains, especially cereals, vegetables, legumes, and fruits, which thereby reduces both calorie and fat intake. Such dietary improvements will not only reduce cancer and other chronic disease risks, but will contribute to a healthy life to an advanced age. A corollary benefit is a lower cost of medical care.

The first year effectiveness of a new comprehensive nutrition education program for preschool children, Healthy Start, was assessed using a project-developed, multiple choice picture identification test, the Knowledge Quiz. Eight hundred fourteen children in nine Head Start centers in three counties in New York State participated in the study. The two experimental groups (A and B) received either (1) the meal and snack food intervention (FI) and the nutrition curriculum (NUT), or (2) the FI and a control curriculum; the control (C) received the standard Head Start food menu and the control curriculum. A quasi-experimental pre/posttest research design was employed with the appropriate pretest and two contrast-coded variables entered as the predictor variables into separate regression analyses for the nutrition and overall assessments. The results showed that Groups A and B scored higher on average, adjusting for pretest variation, than Group C on both nutrition (p < .002) and overall (p < .001) me...

The purpose of this article is to describe the development of a new comprehensive preschool health education program, Healthy Start. It includes a 12-unit curriculum with topics in nutrition, safety, self-esteem, body parts, family relations, dental health and hygiene, environment, drug education, and violence prevention. The philosophy, framework, and content of the curriculum are based on contemporary educational and behavioral research as well as theoretical models regarding how children learn and how learning influences behavior.

Healthy Start is a three year research project designed to evaluate the effectiveness of a cardiovascular risk reduction program in minority and low-income children and their parents. Baseline 24-hour recall data was collected on 439 three to five year-old children during the Fall of 1995. The methodology used was a combined approach: observation of the children during mealtime to determine quantities of food eaten at school coupled with completion of a food record by the parent/guardian of the child for foods eaten away from school on the same day as the observation. The food record was reviewed by phone with the parent/guardian for accuracy and completeness. In the absence of a completed food record, the parent was asked to recall the child's intake on the day in question. School meal plus home meal intake was merged for each child to create the 24-hour intake. The collection method was done according to specific criteria. The mean caloric intake was 1449 kcal, with 15% of energy from protein, 54% from carbohydrate, 31% from fat and 12% from saturated fat. This combined approach methodology allows 24-hour intakes to be collected on young children in the school setting as well as the home environment.

Healthy Start is a 3–year demonstration and education research project to evaluate the effectiveness of a coronary heart disease risk reduction program in Head Start centers in New York State. The primary goal of the program is to demonstrate that it is possible and safe to reduce young children's intake of fat to desirable levels. The development and initial implementation of the nutrition intervention component of the program are described in this report. Nutrition intervention includes nutrition education for the children's care givers and modifications in the foodservice operation in each of the study's six intervention sites. Recommendations are provided to guide educators in future research and practice.

Evaluation of obese children and adolescents in the pediatric office or clinic should include baseline assessment of weight for height and body fatness; rule out endocrine and genetic causes of obesity; and evaluate other health-risk factors, such as those for cardiovascular disease, cancer, diabetes, and hypertension. Treatment of obesity is most successful if realistic goals are set; a balanced low-fat/high-fiber diet is stressed; a safe rate of weight loss of 1 to 2 pounds per week is achieved through a moderate reduction of caloric intake (approximately 20-25% decrease); increased physical activity is stressed as much as diet; parental support is strong; and behavior therapy is provided during the course of treatment to help both child and parent achieve the diet, exercise, and behavior goals.

Objectives: Although dietary fiber is associated with important health benefits in childhood, there have been concerns that very high fiber diets may result in adverse health effects. This report reviews the major safety concerns associated with consumption of very high fiber diets, estimates the amount of fiber that may cause adverse physiologic effects in children, and proposes safe levels of dietary fiber intake for children and adolescents. Methods. Published studies on dietary fiber intake in childhood were reviewed to determine major safety concerns, to document adverse effects, to characterize subjects involved and the dose and type of fiber consumed, and to estimate potential relevance to US children and adolescents. Levels of dietary fiber reported to have adverse health effects were compared with recommended levels of fiber intake for children older than 2 years of age. Results and Conclusions. A review of the scientific literature suggests that a small loss of energy, protein, and fat may occur with a high intake of dietary fiber. However, this small loss of energy is unlikely to be significant to children consuming adequate levels of major nutrients, especially at conservative fiber intakes as recommended by the American Health Foundation's age plus 5 formula. In addition, it is estimated that even with a doubling of current dietary fiber, there is unlikely to be an adverse effect on serum vitamin and mineral concentrations in healthy US children consuming a balanced diet containing adequate levels of nutrients. Thus, evidence suggests that for US children, a moderate increase in dietary fiber is more likely to be healthful than harmful.

Objective. The consumption of dietary fiber in childhood is associated with important health benefits, especially with respect to promoting normal laxation. Dietary fiber also may help reduce the future risk of cardiovascular disease, some cancers, and adultonset diabetes. At present, there are few specific guidelines for dietary fiber intake in childhood. Our goals were to review the benefits and risks of dietary fiber in childhood and to propose a safe and effective quantitative recommendation for the US pediatric population. Method. Current intake of dietary fiber in childhood was reviewed, including data from the US Department of Agriculture Nationwide Food Consumption (1987-1988) and National Health and Nutrition Examination II (1976-1980) Survey. Current intake was compared with existing fiber recommendations, including the 0.5-g/kg guideline proposed by the American Academy of Pediatrics Committee on Nutrition. Recommended fiber intake was reviewed with respect to levels required for specific health benefits, as well as levels that may result in adverse health effects. Results and Conclusions. A new recommendation for dietary fiber intake was developed, based on the age of the child, health benefits, and safety concerns. We recommended that children older than 2 years of age consume a minimal amount of dietary fiber equivalent to age plus 5 g/d. A safe range of dietary fiber intake for children is suggested to be between age plus 5 and age plus 10 g/d. This range of dietary fiber intake is thought to be safe even if intake of some vitamins and minerals is marginal, should provide enough fiber for normal laxation, and may help prevent future chronic disease.

Primary care physicians play a pivotal role in the successful implementation of the National Cholesterol Educational Program (NCEP) guidelines for both population and high-risk approaches to reduce blood cholesterol levels in children and adults. Increasingly, in this era of health cost containment, the primary care physician is recognized as (1) the main and sometimes the only source of health care for large numbers of individuals; (2) the affordable physician and (3) the gatekeeper for referral to medical specialists. Achievement of NCEP guidelines for cholesterol reduction, American Heart Association (AHA) guidelines for prevention of cardiovascular disease, and Year 2000 National Objectives for Health Promotion and Disease Prevention will all rely heavily on the active cooperation and support of practicing internists, pediatricians, and family/general practitioners in providing patient education, risk factor evaluation and intervention. Although the majority of primary care physicians intuitively support the concept of preventive cardiology and generally have a high level of knowledge of cardiovascular risk factors, a significant gap remains between physician knowledge and attitudes and the actual practice of preventive cardiology in clinical practice. Despite these limitations in implementation of clinical guidelines, significant progress has been made in the past decade in reaching NCEP and Year 2000 goals for population-wide cholesterol reduction.

Energy density is a relatively new concept that has been identified as an important factor in body weight control in adults and in children and adolescents. The Dietary Guidelines for Americans 2010 encourages consumption of an eating pattern low in energy density to manage body weight. This article describes the systematic evidence-based review conducted by the 2010 Dietary Guidelines Advisory Committee (DGAC), with support from the US Department of Agriculture's Nutrition Evidence Library, which resulted in this recommendation. An update to the committee's review was prepared for this article. PubMed was searched for English-language publications from January 1980 to May 2011. The literature review included 17 studies (seven randomized controlled trials, one nonrandomized controlled trial, and nine cohort studies) in adults and six cohort studies in children and adolescents. Based on this evidence, the 2010 Dietary Guidelines Advisory Committee concluded that strong and consistent evidence in adults indicates that dietary patterns relatively low in energy density improve weight loss and weight maintenance. In addition, the committee concluded that there was moderately strong evidence from methodologically rigorous longitudinal cohort studies in children and adolescents to suggest that there is a positive association between dietary energy density and increased adiposity. This review supports a relationship between energy density and body weight in adults and in children and adolescents such that consuming diets lower in energy density may be an effective strategy for managing body weight.

Previous studies show that divorced men exhibit high rates of psychological distress, alcohol abuse, and mortality. Using data from a recent national survey, we consider the possibility that these problems reflect strains associated with being a divorced father. The results show that divorced fathers report substantially higher levels of parental role strain than do married fathers. The data further indicate that the estimated effects of divorce on men's psychological distress levels and alcohol consumption are explained, in part, by higher levels of parental role strain among divorced men. Qualitative data from an in-depth interview study of 45 divorced fathers are examined to consider possible reasons why parenting in the divorced status may be conducive to parental role strain, psychological distress, and alcohol abuse.

Dietary fiber intake provides many health benefits. However, average fiber intakes for US children and adults are less than half of the recommended levels. Individuals with high intakes of dietary fiber appear to be at significantly lower risk for developing coronary heart disease, stroke, hypertension, diabetes, obesity, and certain gastrointestinal diseases. Increasing fiber intake lowers blood pressure and serum cholesterol levels. Increased intake of soluble fiber improves glycemia and insulin sensitivity in non-diabetic and diabetic individuals. Fiber supplementation in obese individuals significantly enhances weight loss. Increased fiber intake benefits a number of gastrointestinal disorders including the following: gastroesophageal reflux disease, duodenal ulcer, diverticulitis, constipation, and hemorrhoids. Prebiotic fibers appear to enhance immune function. Dietary fiber intake provides similar benefits for children as for adults. The recommended dietary fiber intakes for children and adults are 14 g/1000 kcal. More effective communication and consumer education is required to enhance fiber consumption from foods or supplements. © 2009 International Life Sciences Institute.

In 1982 and 1983 practicing pediatricians in a Lyme disease-endemic county, reported 90 cases of Lyme disease among children 19 years of age and younger (median age, 9 years). Three-fourths of the children had initial symptom onset in the summer months, with peak incidence in July. Infection occurred twice as often in boys than in girls, and tick bites were recalled by less than half (49%) of the children or parents. Erythema chronicum migrans was present in two-thirds (67%) of the cases with median onset 7 days after a definite tick bite. Arthritis or arthralgia occurred in 59% and neurologic symptoms, especially seventh nerve palsy, occurred in 14%. Asymmetric involvement of a few large joints, especially the knee, was most commonly reported for those with joint involvement. antibiotics were prescribed for 79% of the children, three-fourths of whom were treated with oral penicillin. Initial diagnosis of Lyme disease is usually made on clinical grounds alone because serologic tests are often negative. Serologic tests for antibody to Borrelia burgdorferi were more often positive in cases with neurological or joint involvement, in addition to erythema chronicums migrans (80%), than in cases presenting with erythema chronicums migrans only.

Cardiovascular disease (CVD) is a leading cause of morbidity and premature mortality in women and men in the United States, most of the industrialized world, and many developing countries.1 Data accumulated over the past 3 decades indicate that atherosclerotic-CVD processes begin early in childhood and are influenced over the life course by genetic and potentially modifiable risk factors and environmental exposures. Taken together, these data provide compelling evidence for primary prevention of CVD beginning early in childhood. Within the pediatric healthcare community, this evidence has prompted and informed the development of science-based guidelines with recommendations for individual/high-risk and population-based approaches to primary prevention of CVD in children and youth. The purpose of this statement is to provide an overview of the evidence and current science-based recommendations and to emphasize the role of advanced practice nurses in the implementation of strategies consistent with population-based and individual/high-risk approaches to CVD prevention in children and youth. Evidence-based guidelines for primary and secondary prevention of CVD in adults are informed by the results of randomized controlled trials. The existing evidence (discussed below) argues convincingly for prevention of CVD beginning early in childhood. It is noteworthy that data from randomized controlled trials documenting the effect of risk reduction in childhood on the development of CVD in adulthood are nonexistent. Similarly, no long-term longitudinal studies have been conducted to determine the absolute levels of risk factors measured in childhood that predict CVD in adult life. However, evidence from laboratory, clinical, and epidemiological studies supports the need for primary prevention of CVD beginning early in life and has prompted and informed existing guidelines for children and adolescents. ### Laboratory/Pathology and In Vivo/Clinical Studies Autopsy studies conducted as part of the Bogalusa Heart Study2,3 and the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Study4,5 demonstrate significant positive associations between potentially modifiable …

Objective This report describes a pilot study to evaluate Animal Trackers (AT), a preschool program designed to (1) increase structured physical activity (PA) during the preschool day; (2) increase practice of gross motor skills; (3) provide teachers with an easy-to-use PA program regardless of teacher experience; and (4) implement a teacher walking intervention. Design Pilot observational study in volunteer preschools. Setting Nine preschools in New Mexico. Participants Two-hundred seventy 3- to 5-year-old children and 32 teachers. Intervention Daily 10-minute classroom activities for children. Main Outcome Measure Implementation and duration of AT activities, teacher preparation time, and added weekly time spent in structured PA. Analysis Process evaluation to track program implementation, and pre-post measures to assess outcomes. Results AT activities were implemented 4.1 times per week (11.4 minutes/activity), with 7 minutes teacher preparation time. Overall, AT added 47 minutes of structured PA per week for children. Conclusions and Implications The AT program increased structured PA time in preschools. Teachers felt that AT was developmentally appropriate; that children enjoyed the activities; and that the children's motor skills improved. Results of the pilot study are encouraging, since research suggests that even small increases in PA could help prevent obesity.

Cardiovascular disease (CVD) is a major cause of morbidity and premature mortality in men and women in the United States, most of the industrialized world, and many developing countries.1 Primary prevention of CVD beginning in early childhood is supported by extensive evidence culled from epidemiological, clinical, and laboratory studies.2–16 Taken together, these data provided the impetus for the American Heart Association (AHA) Guidelines for Primary Prevention of Atherosclerotic Cardiovascular Disease Beginning in Childhood17 and support the need for population-based approaches to cardiovascular health promotion and risk reduction. Specifically, the population-based approach, which is aimed at modifying the food and physical activity environments of children, is an important concomitant to the high-risk approach because without the proper environment, the high-risk strategy cannot be optimally implemented. School health programs initiated in preschool and extending through high school have the potential to influence the cardiovascular health of the majority of US children and youth. Toward this goal, this statement is intended for health and education professionals, child health advocates, policymakers, and community leaders who are interested in optimizing the school environment as an integral part of population-based strategies designed to promote cardiovascular health for all US children and youth and reduce the risk and public health burden of CVD. Several lines of evidence underscore the importance of primary prevention of CVD beginning in childhood and the need for population-based approaches to cardiovascular health promotion and risk reduction. Autopsy studies (after the unexpected deaths of children and youth)2–5 document significant positive associations between established risk factors and the presence and extent of atherosclerotic lesions in the aorta and coronary arteries of children and youth. Specifically, data from the Bogalusa Heart Study3,4 and the Pathobiological Determinants of Atherosclerosis in Youth (PDAY)2,5 study link potentially modifiable risk factors, including atherogenic …

Cardiovascular disease (CVD) is the largest killer of women in the United States.1 More than 500 000 women die of CVD annually, more than the number of CVD-related deaths in men or related to the next 7 causes of death in women combined.1 Despite these statistics, a national survey in 2003 by the American Heart Association (AHA) showed that less than half of all women know that CVD is their leading cause of death.2 In an effort to raise awareness and educate health care providers and the public about methods to prevent incident and recurrent CVD events, an expert panel was convened to establish evidence-based guidelines for the prevention of CVD in women. The panel consisted of representatives from 11 AHA Scientific Councils and 11 federal and other professional organizations. There were an additional 22 endorsers. Details of the process and the complete guidelines have been published.3 See page e29 Briefly, candidate recommendations for CVD risk-reducing interventions were discussed, prioritized, and then selected for a systematic literature search. Randomized, clinical trials and large, prospective, cohort studies evaluating cardiovascular risk-reducing interventions with a focus on major clinical endpoints (death, myocardial infarction [MI], stroke, revascularization procedure, congestive heart failure, or a composite CVD endpoint), whether or not there were female participants, were included. Nearly 7000 abstracts were identified in the initial search; 1279 were included for full-text screening and 399 studies were included in the summary evidence tables for each recommendation, with sex-specific information if available. The evidence tables are published online at http://atvb.ahajournals.org. The expert panel used an evidence rating system based on methods used in previous AHA/American College of Cardiology (ACC) guidelines and is outlined in Table 1.4 In addition, a generalizability index was used to rate the likelihood that results generated from studies …

Significant advances in our knowledge about interventions to prevent cardiovascular disease (CVD) have occurred since publication of the first female-specific recommendations for preventive cardiology in 1999.1 Despite research-based gains in the treatment of CVD, it remains the leading killer of women in the United States and in most developed areas of the world.2–3 In the United States alone, more than one half million women die of CVD each year, exceeding the number of deaths in men and the next 7 causes of death in women combined. This translates into approximately 1 death every minute.2 Coronary heart disease (CHD) accounts for the majority of CVD deaths in women, disproportionately afflicts racial and ethnic minorities, and is a prime target for prevention.1–2 Because CHD is often fatal, and because nearly two thirds of women who die suddenly have no previously recognized symptoms, it is essential to prevent CHD.2 Other forms of atherosclerotic/thrombotic CVD, such as cerebrovascular disease and peripheral arterial disease, are critically important in women. Strategies known to reduce the burden of CHD may have substantial benefits for the prevention of noncoronary atherosclerosis, although they have been studied less extensively in some of these settings. In the wake of the reports of the Women’s Health Initiative and the Heart and Estrogen/Progestin Replacement Study (HERS), which unexpectedly showed that combination hormone therapy was associated with adverse CVD effects, there is a heightened need to critically review and document strategies to prevent CVD in women.4–7 These studies underscore the importance of evidence-based practice for chronic disease prevention. Optimal translation and implementation of science to improve preventive care should include a rigorous process of evaluation and clear communication about the quantity and quality of evidence used to support clinical recommendations. Recently, there has been an increase in the …

Coronary heart disease remains the leading cause of death in the United States, responsible for close to half a million deaths each year. During the past two decades, convincing evidence has emerged that links defined risk factors in adults with an accelerated atherosclerotic process. Pathological data have shown that atherosclerosis begins in childhood and that the extent of atherosclerotic change in children and young adults can be correlated with the presence of the same risk factors identified in adults. It thus seems eminently reasonable to initiate healthful lifestyle training in childhood to promote improved cardiovascular health in adult life. The goal of this document is to provide strategies for promoting cardiovascular health that can be integrated into the comprehensive pediatric care of children. The following critical areas are reviewed: physical activity, obesity, insulin resistance and type II diabetes mellitus, hypertension, high blood cholesterol, and cigarette smoking. Background information, methods of assessment, and means for intervention are discussed for each major area. A cardiovascular health schedule has been developed to help the practitioner implement these suggestions within the framework of comprehensive pediatric care. Rather than labeling specific children as abnormal, strategies are directed toward promoting optimal cardiovascular health for all children. ### Background The health benefits associated with a physically active lifestyle in children include weight control, lower blood pressure, improved psychological well-being, and a predisposition to increased physical activity in adulthood. Increased physical activity has been associated with an increased life expectancy and decreased risk of cardiovascular disease (CVD). Healthy levels of physical fitness require regular (4 to 5 times per week) participation in activities that generate energy expenditures significantly above the resting level and ideally ≥50% to 60% of maximal exertion. Activities that result in significant energy expenditures in children may include both recreational and organized or competitive sporting activities. Physical …

To determine mean intake of energy and protein, total fat, saturated fat, percent energy from total and saturated fat, cholesterol, carbohydrate, calcium, iron, zinc, folate, vitamins A, C, E, B-6 and B-12, thiamin, niacin, riboflavin, magnesium, sodium and fiber of preschool Head Start children at school and away from school.Twenty-four-hour food intakes for 358 Head Start children were obtained by observing food intake at school and acquiring intake recalls from parents or guardians specifying food their children consumed for the balance of the day. After determining group estimates of energy and nutrient intake, mean intake was compared to standard nutrient recommendations for the entire 24-hour day, i.e., for the time the children were in school and for the remaining hours away from school ("home" intake).The 358 Head Start children attended school either half-day (2- to 3-hour AM and PM sessions) or all-day (5 to 6 hours).Differences in nutrient intake among class times were analyzed using one-way analysis of variance (ANOVA) followed by Tukey's multiple comparison test. Differences with a p-value0.05 (two-tailed) were considered to be statistically significant. Total energy, protein, calcium, iron, zinc, vitamins A, C, E, B6, and B12, thiamin, niacin, riboflavin as well as folate and magnesium were compared to the Recommended Dietary Allowances for the 4- to 6-year-old age group. Other standards that were used for comparisons included the National Cholesterol Education Program (fat, saturated fat and cholesterol), the 1989 National Research Council's Diet and Health Report (carbohydrate and sodium) and the recommendation for fiber proposed by the American Health Foundation.At school, half-day children consumed up to 25% of the daily recommendation for energy and nutrients, while all-day children achieved at least a third of the recommended intakes. When intakes at home and school were combined, all three groups of children (AM, PM and all-day) exceeded dietary recommendations for protein, vitamins and minerals. Energy intake remained below 100% of the recommendation, while intake of total fat, saturated fat and cholesterol exceeded recommendations.Further research is required to explore energy needs and determine nutritional status and nutrient needs of minority and low-income preschool children. Strategies are required to increase nutrient density, but not fat density, of meals and snacks served to children who attend day care for part of the day. Finally, school meals and nutrition education programs such as Team Nutrition should broaden their base to include healthful eating habits for all school children, including the very youngest children in preschool programs.

Objective. The aim of this study was to assess the safety and efficacy of lowering dietary intake of total fat, saturated fat, and cholesterol in growing children and adolescents with severe hyperlipidemia. Study Design. This is a 3-year follow-up study conducted on a sample of convenience at three pediatric referral centers in New York City and its suburbs. Subjects were 138 children and adolescents 2 to 15 years of age (54% male), who had been referred with a diagnosis of hyperlipidemia. Those selected had total serum cholesterol values greater than the 95th percentile for age and had at least three visits over 3 years. They were placed on diets restricting total fat content to 30% of total calories and saturated fat to 10% of total calories (National Cholesterol Education Program Step I diet). Anthropometric measures, lipid profiles, and dietary assessment were obtained at each visit. Anthropometric data were analyzed by sex and age. Z scores for height and weight were calculated from NHANES II data and were compared by paired t tests (Hamill et al., 1979, Am J Clin Nutr 32:607–29). Results. Total serum cholesterol dropped from 262 mg/dL at baseline to 249 mg/dL at 3-year follow-up ( P = 0.003). There was no significant change in height or weight percentile, expressed as Z score, from baseline to 3-year follow up. Conclusions. In this population the supervised dietary interventions resulted in a sustained improvement of the lipid profile, with no demonstable adverse effect on growth.

ContextHeterozygous familial hypercholesterolemia (HeFH) is a common disorder associated with early coronary artery disease, especially in men. The age at which drug therapy should be started is still controversial, as is the use of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins).ObjectiveTo assess the lipid-lowering efficacy, biochemical safety, and effect on growth and sexual development of lovastatin in adolescent boys with HeFH.DesignOne-year, double-blind, placebo-controlled, balanced, 2-period, 2-arm randomized trial. In the first period (24 weeks), lovastatin was increased at 8 and 16 weeks and the dosage remained stable during the second period (24 weeks). The study was conducted between 1990 and 1994.SettingFourteen pediatric outpatient clinics in the United States and Finland.PatientsBoys aged 10 to 17 years with HeFH. Of 132 randomized subjects (67 intervention, 65 placebo), 122 (63 intervention, 59 placebo) and 110 (61 intervention, 49 placebo) completed the first and second periods, respectively.InterventionLovastatin, starting at 10 mg/d, with a forced titration at 8 and 16 weeks to 20 and 40 mg/d, respectively, or placebo.Main Outcome MeasuresThe primary efficacy outcome measure was low-density lipoprotein cholesterol (LDL-C). Primary safety measures were growth and sexual development.ResultsCompared with placebo, LDL-C levels of patients receiving lovastatin decreased significantly (P

Background. Healthy Start is a 3-year demonstration and education research project designed to evaluate the effectiveness of a multidimensional cardiovascular (CV) risk reduction intervention in preschool centers over a 3-year period of time. Methods. Two primary interventions are employed. The first is the preschool food service intervention program designed to reduce the total fat in preschool meals and snacks to less than 30% of calories and reduce the saturated fat to less than 10% of calories. The second major intervention is a comprehensive preschool health education curriculum, focused heavily on nutrition. Results. Effectiveness of the intervention will be determined through evaluation of changes in dietary intake of preschool children at school meals and snacks, especially with respect to intake of total and saturated fat. Evaluation of the education component will include assessment of program implementation by teachers, assessment of changes in nutrition knowledge by preschool children, and assessment of changes in home meals that children consume (total and saturated fat content). Blood cholesterol will be evaluated semiannually to evaluate changes that may be due to modification of dietary intake. Growth and body fatness will also be assessed. Conclusions. While substantial efforts have targeted CV risk reduction and health education for elementary school children, similar efforts aimed at preschool children have been lacking. The rationale for beginning CV risk reduction programs for preschool children is based upon the premise that risk factors for heart disease are prevalent by 3 years of age and tend to track over time, most commonly hypercholesterolemia and obesity, both related to nutrition. Since the behavioral antecedents for nutritional risk factors begin to be established very early in life, it is important to develop and evaluate new educational initiatives such as Healthy Start , aimed at the primary prevention of cardiovascular risk factors in preschool children. The purpose of this publication is to describe the rationale and methods for the Healthy Start project.

Objective : The purpose of the study was to determine if prenatal exposure to Lyme disease was associated with an increased risk of adverse pregnancy outcome. Study design : Approximately 2000 Westchester County, New York, women completed questionnaires and had sera tested for antibody to Borrelia burgdorferi at their first prenatal visit and at delivery. Fetal death, birth weight, length of gestation at delivery, and congenital malformations were examined in relation to maternal Lyme disease exposure before and during pregnancy. Results : Maternal Lyme disease or an increased risk of exposure to Lyme disease was not associated with fetal death, decreased birth weight, or length of gestation at delivery. Tick bites or Lyme disease around the time of conception was not associated with congenital malformations. Tick bites within 3 years preceding conception were significantly associated with congenital malformations, but this could have reflected reporting differences between exposed and unexposed women. Conclusions : Maternal exposure to Lyme disease before conception or during pregnancy is not associated with fetal death, prematurity, or congenital malformations taken as a whole. We have not ruled out the possibility that exposure to Lyme disease as defined by maternal history increases the risk of specific malformations or has an effect if it is not treated. We have insufficient numbers of women who were seropositive at their first prenatal visit to determine if this subgroup of exposed women are at a moderately increased risk of having a child with a congenital abnormality. The low frequency of seroconversion at delivery in this endemic area suggests that preventive measures are being taken by obstetricians and patients.