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Knowledge of measured energy expenditure (EE) during walking and running is important for exercise prescription. Further, research on the EE comparison and EE predicted equation during walking or running among different ethnicities is limited. The purpose of the current study was to compare EE to walk or run 1 mile in Caucasian, African American and Asian adults and to develop a regression equation to predict EE to walk or run 1 mile. Two hundred and twenty-four participants were included (71 Caucasians, 68 African Americans and 85 Asians) with 3 groups (normal weight walking, overweight walking and running). EE was measured via indirect calorimetry. Analysis of variance was used to compare EE across groups. Multiple regression analysis was employed for EE prediction, and the prediction equation was cross-validated. A significant EE difference was found between walking and running among three ethnicities. The prediction equation was: EE ​= ​0.978 Body Weight – 4.571 Gender (male=1; female=2) ​+ ​3.524 Ethnicities (Caucasians=1, African Americans=2, Asians=3) ​+ ​32.447 (standard error of estimate=12.5 ​kcal·mile−1). The equation was valid through cross-validation, so it is recommended to apply for calculating EE during walking or running 1 mile among Caucasians, African Americans and Asians.

Background and objectives Selected beverages, such as sugar-sweetened beverages, have been reported to influence kidney disease risk, although previous studies have been inconsistent. Further research is necessary to comprehensively evaluate all types of beverages in association with CKD risk to better inform dietary guidelines. Design, setting, participants, & measurements We conducted a prospective analysis in the Jackson Heart Study, a cohort of black men and women in Jackson, Mississippi. Beverage intake was assessed using a food frequency questionnaire administered at baseline (2000–2004). Incident CKD was defined as onset of eGFR Results Among 3003 participants, 185 (6%) developed incident CKD over a median follow-up of 8 years. At baseline, mean age was 54 (SD 12) years, 64% were women, and mean eGFR was 98 (SD 18) ml/min per 1.73 m2. After adjusting for total energy intake, age, sex, education, body mass index, smoking, physical activity, hypertension, diabetes, HDL cholesterol, LDL cholesterol, history of cardiovascular disease, and baseline eGFR, a principal components analysis–derived beverage pattern consisting of higher consumption of soda, sweetened fruit drinks, and water was associated with significantly greater odds of incident CKD (odds ratio tertile 3 versus 1 =1.61; 95% confidence interval, 1.07 to 2.41). Conclusions Higher consumption of sugar-sweetened beverages was associated with an elevated risk of subsequent CKD in this community-based cohort of black Americans.

OBJECTIVES: Red and processed meat consumption is adversely related to cardiometabolic risk, but the impact of overall dietary quality on this association has not been systematically investigated. We examined the influence of dietary quality on associations of meat intake with biomarkers of cardiometabolic risk. METHODS: Data are from the Jackson Heart Study, a cohort of African Americans (baseline age 55 y, 66% female, 20% diabetes, 9% CVD). We analyzed those with biomarker data available at Visit 1 (2000–04) and at Visit 2 (2005–09) or 3 (2009–13). Diet was assessed by food frequency questionnaire (Visit 1). Total observations used were: Visit 1 (n = 3725), Visit 2 (n = 2736), and Visit 3 (n = 3319). Unprocessed red meat included beef and pork, and processed meat included sausage, lunch, and cured meats. Diet quality was measured by a modified Healthy Eating Index 2010 score (m-HEI) that excluded meat contributions. Modified HEI stratified and unstratified analyses were conducted using linear mixed modeling. Fasting HbA1c and CRP values were log transformed. RESULTS: Meat consumption was not associated with HbA1c in m-HEI stratified or unstratified analyses. A 1 oz/1000 kcal/wk increase in unprocessed red and total meat was associated with a 1.3% ± 0.5% (P = 0.02) and 1.1% ± 0.3% (P = 0.005) higher CRP in unstratified analyses, respectively. Unprocessed red meat was positively associated with CRP in m-HEI tertiles 1 (2.0% ± 0.8%, P = 0.01) and 3 (2.2% ± 0.8%, P = 0.008). Total meat was associated with CRP in m-HEI tertile 1 (2.0% ± 0.6%, P = 0.001) and trended in tertile 3 (1.1% ± 0.6%, P = 0.09); processed meat also approached significance in m-HEI tertile 1 (2.1% ± 1.2%, P = 0.08). There was evidence that m-HEI modified the associations between processed meat and CRP (P-interaction = 0.04), but not for other associations. Excluding those with diabetes or CVD did not alter these results. CONCLUSIONS: Our results do not support that meat intake is associated with HbA1c, or that overall dietary quality modifies these associations. Unprocessed red and total meat intakes were associated with greater CRP in unstratified and subsets of stratified analyses. Associations of processed meat with CRP appeared stronger among those with the poorest diet quality. These data suggest that reduction in red meat intake could benefit inflammation among African American adults. FUNDING SOURCES: The Beef Checkoff.

BACKGROUND Higher dietary phosphorus is associated with left ventricular hypertrophy and mortality, which are blood pressure (BP)-related outcomes. For this reason, we hypothesized that dietary phosphorus may be associated with adverse clinic and ambulatory BP patterns. METHODS Our study included 973 African American adults enrolled in the Jackson Heart Study (2000–2004) with 24-hour ambulatory BP monitoring (ABPM) data at baseline. We quantified dietary phosphorus from a validated Food Frequency Questionnaire as follows: (i) absolute daily intake, (ii) ratio of phosphorus-to-protein intake, (iii) phosphorus density, and (iv) energy-adjusted phosphorus intake. Using multivariable linear regression, we determined associations between dietary phosphorus intake and systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure in clinic and over daytime, nighttime, and 24-hour periods from ABPM. Extent of nocturnal BP dipping was also assessed. Using logistic regression, we modeled relationships between dietary phosphorus intake and clinically relevant qualitative BP phenotypes, such as masked, sustained, or white-coat hypertension and normotension. RESULTS There were no statistically significant associations between phosphorus intake and SBP or pulse pressure in adjusted models. Most metrics of higher phosphorus intake were associated with lower daytime, nighttime, and clinic DBP. Higher phosphorus intake was not associated with clinic or ABPM-defined hypertension overall, but most metrics of higher phosphorus intake were associated with lower odds of sustained hypertension compared to sustained normotension, white-coat hypertension, and masked hypertension. There were no associations between dietary phosphorus and nocturnal BP dipping. CONCLUSIONS These data do not support a role for higher phosphorus intake and higher BP in African Americans.

BACKGROUND Despite the federal initiatives on equitable provision of school nutrition programs, geographic disparity in childhood obesity persists. It may be partly because built-in school nutrition environments rely on each school's efficient use of existing operational funds or its ability to obtain expanded financial support. This study explores how funding acquisition by schools is determined by local community characteristics and how it relates to healthy school meal offerings. METHODS Information about food preparation technology and funding in 811 schools in Mississippi was obtained by in-depth phone interviews of district child nutrition directors and school foodservice managers, which was matched to socioeconomic indicators of schools and communities. Probit models were estimated. RESULTS About 56% of schools in the sample received some funds toward combination oven/steamers in the last few years. Small schools, schools in non-metro counties, and those in low-income minority areas were significantly less likely to be funded. Obtainment of funds was associated with a 45 percentage-point reduction in the probability of serving fried foods. CONCLUSIONS Funds obtained by schools for advanced food preparation technology contributes to creation of healthier nutrition environments for children. However, fund availability is associated with community characteristics, possibly contributing to geographic disparity of child health.

Objective Dietary protein intake could have deleterious renal effects in populations at risk for chronic kidney disease. Here, we examined whether higher protein intake (≥80th percentile of energy from protein) is associated with decline in kidney function and whether this decline varies by diabetes status. Design Observational cohort study. Subjects and Settings Participants were African-Americans (n = 5,301), who enrolled in the Jackson Heart Study between 2000 and 2004. Methods Dietary intake was assessed using a validated food-frequency questionnaire at baseline, and serum creatinine was measured at baseline (visit 1) and 8 years later (visit 3). Estimated glomerular filtration rates (eGFRs) at baseline and follow-up were computed using the chronic kidney disease epidemiology collaboration equation. Main Outcome Measure The change in eGFR was computed by subtracting eGFR at visit 1 from that at visit 3. Results Of 3,165 participants with complete data, 64% were women, 57% had hypertension, and 19% had diabetes. The median (25th, 75th percentile) percent energy intake from protein was 14.3 (12.4, 16.4), comparable to that reported for the general US population (15% of energy). During a median (25th, 75th percentile) follow-up of 8.0 (7.4, 8.3) years, eGFR declined by 10.5% from a mean (SD) of 97.4 (17.5) to 86.9 (21.3) mL/min/1.73 m 2 . In the fully adjusted model, consumption of protein as percent of energy intake in lowest and highest quintiles was associated with decline in eGFR among diabetic subjects. The analysis of variance with a robust variance estimator was used to determine whether long-term change in eGFR significantly varies by protein intake. Conclusions Our results show that, among African-Americans with diabetes, higher protein intake as a percent of total energy intake is positively associated with greater decline in eGFR in analyses that accounted for risk factors for kidney disease.

The purpose of this study was to 1) evaluate whether physical activity has a protective effect on incident diabetes among African Americans across combinations of body mass index (BMI) and waist circumference (WC), 2) evaluate the effect of changes on BMI and WC on incident diabetes, and 3) evaluate the effect of 'normal range' glycated hemoglobin (A1C) on incident diabetes.Data from the prospective Jackson Heart Study were evaluated, with baseline data assessed between 2001 and 2004 and follow-up data occurring between 2009 and 2013. Physical activity was assessed via a validated questionnaire, with measured BMI, WC and A1C assessed via standard procedures.The sample included 2,450 adults who did not have evidence of diabetes at the baseline assessment, with 286 incident diabetes cases occurring at the follow-up assessment. Physical activity did not have a protective effect against incident diabetes across different BMI and WC combinations. Notably, BMI change from baseline to follow-up was associated with incident diabetes (HR = 1.08; 95% CI: 1.03-1.13). Further, higher levels of A1C within the 'normal-range' was associated with incident diabetes (HR = 7.51, 95% CI = 2.66-21.25).Increases in BMI over time and higher A1C within the normal range were associated with incident diabetes. Serial monitoring of BMI, as well as A1C, even among those with a 'normal' A1C, may be warranted by clinicians. Future work evaluating this novel three-way model (physical activity, BMI and WC) should consider utilizing an objective measure of physical activity.

Objective: To examine the relative association of abdominal visceral adipose tissue (VAT) with cardiometabolic risk factors between African and European Americans. Design and Methods: We conducted a cross-sectional study of 2035 African Americans from Jackson Heart Study (JHS) and 3170 European Americans from Framingham Heart Study (FHS) who underwent computed tomography assessment of VAT and subcutaneous adipose tissue (SAT). The FHS participants were weighted to match the age distribution of the JHS participants and the metabolic risk factors were examined by study groups in relation to VAT. Results: JHS participants had higher rates of obesity, hypertension, diabetes and metabolic syndrome than FHS participants (all p = 0.001). The associations were weaker in JHS women for VAT with blood pressure, triglycerides, HDL-C, and total cholesterol (pinteraction = 0.03 to 0.001) than FHS women. In contrast, JHS men had stronger associations for VAT with high triglycerides, low HDL, and metabolic syndrome (all pinteraction = 0.001) compared to FHS men. Similar associations and gender patterns existed for SAT with most metabolic risk factors. Conclusions: The relative association between VAT and cardiometabolic risk factors is weaker in JHS women compared to FHS women, whereas stronger association with triglycerides and HDL were observed in JHS men.

Approximately 600 different carotenoids are known to exist in nature(1). Whereas plants, fungi, algae and bacteria can synthesise these compounds, animals cannot and therefore need to obtain them from their diet(2). The only clearly proven function of carotenoids in humans is their provitamin A activity. The major carotenoids found in human sera are α- and β-carotene, lycopene, lutein, zeaxanthin and cryptoxanthin. Of these, α- and β-carotene and β-cryptoxanthin have provitamin A activity(3). Recently, non provitamin A-related activities of carotenoids have received attention. These include possible contribution to reducing the risk for diseases such as cardiovascular disease (CVD)(4–6), cancer(7–9), cognitive decline(10), age-related macular degeneration and cataract(11–13). However, many of these associations are yet to be proved conclusively. CVD has been a dominant cause of death in the USA for the past 50 or more years. Heart disease and stroke are the first and third specific causes of death in this country. Within the USA, African Americans have the highest rates of morbidity and mortality from CVD, and the south-eastern part of the USA has the highest rates of hospitalisations due to stroke and heart failure(14). Much of the available data relating risk factors and CVD have come from predominantly white populations(15). The Jackson Heart Study (JHS) was therefore initiated to investigate the causes of CVD in an all African American cohort based in Jackson, Mississippi(16). Given the health disparities that exist among African Americans with respect to CVD and the protective role that carotenoid intake and status may play in the prevention of this group of diseases, the objectives of the current study were: To assess the dietary intake and serum concentrations of α- and β-carotene, β-cryptoxanthin, lutein plus zeaxanthin, and lycopene among participants of the Diet and Physical Activity Sub-Study (DPASS) of the JHS using three dietary assessment tools – two regional food-frequency questionnaires (FFQs) and four 24 h recalls. To evaluate the associations between carotenoid intake measures and serum concentrations. To identify the relative contributions of foods to carotenoid intakes in this population.

African Americans in the southern United States have a high prevalence of chronic disease. Tocopherol intake and status have been associated with protection against several chronic diseases. Our objectives were, therefore, to examine the association between tocopherol intakes as measured by 2 regional FFQ and their corresponding concentrations in serum and to report on dietary sources of tocopherols in 404 men and women participating in the cross-sectional Diet and Physical Activity Sub-Study of the Jackson Heart Study. A large proportion (49% of men and 66% of women) reported dietary supplement use. Only 5.8% of men and 4.5% of women met the estimated average requirement (EAR) for vitamin E from foods alone, whereas 44.2% men and 49.2% women met it from foods and supplements. Total (diet + supplement) intake of alpha-tocopherol was associated with its corresponding measure in serum. Vitamin E supplement use, sex, serum cholesterol, education, and BMI, but not gamma-tocopherol intakes, were associated with serum gamma-tocopherol. For delta-tocopherol, associated variables included sex and serum cholesterol. The top food sources of alpha- and gamma-tocopherol were snack chips and the top food source of delta-tocopherol was margarine. Despite prevalent vitamin E supplement use, more than one-half of this population did not meet the EAR for alpha-tocopherol intake and very few met it from food alone. Supplement use was associated with higher alpha- but lower gamma-tocopherol concentration in serum. The possible health implications of this difference in relative tocopherol subtypes require further study.

Background There is a paucity of research examining the relationship between kidney stones and risk of cardiovascular disease while considering individuals of different race-ethnicities. Purpose The purpose of this study was to examine the association between history of kidney stones and increased odds of atherosclerotic cardiovascular disease (via the Pooled Cohort Equations) across race-ethnicity groups. Methods 5571 participants aged 40–79 from the 2007–2012 cycles of the NHANES were used for this study. A history of kidney stones was collected from survey data. Predicted odds of having a 10-year atherosclerotic cardiovascular disease (ASCVD) event was assessed from the Pooled Cohort Equations. Results After adjustments, having kidney stones was not associated with an increase odds of having an ASCVD event within the next 10-years (OR 1.03; 95% CI: 0.58–1.82, P = 0.91). However, among non-Hispanic blacks, those with kidney stones had a 2.24 increased odds (OR 2.24; 95% CI: 1.08–4.66; P = 0.03) of having an ASCVD event within the next 10-years when compared to non-Hispanic blacks with no history of a kidney stone. Conclusion Kidney stones were associated with 10-year risk of a future ASCVD event among non-Hispanic blacks.

Objective:To describe food sources of nutrient intake for white and African American adults in the Lower Mississippi Delta (LMD), and their use in the development of a regional food-frequency questionnaire (FFQ) based on an earlier version of the National Cancer Institute's Health Habits and History Questionnaire.Design:We ranked food sources of energy, macronutrients, vitamins and minerals, and examined portion size distributions for 842 white and 857 African American residents aged 19 years and older, using 24-hour dietary intake recall data from a telephone survey of 36 LMD counties. These values were used to develop a regional FFQ, which was then field-tested with 100 subjects and revised to improve interpretability.Setting:The LMD region of the USA.Subjects:White and African American adult residents of the LMD.Results:LMD African Americans obtained more of their energy and nutrient intakes from poultry, processed meat, salty snacks, fruit drinks, pork and cornbread; and less from milk, alcohol, legumes, salad dressing, butter/margarine and sweetened tea than did white residents. Regional foods not on nationally used FFQs included grits, turnip greens, okra, ham hocks, chitterlings, crawfish, catfish, cracklings, jambalaya, potato logs, chicken and dumplings, and sweet potato pie. Based on responses during field-testing, the questionnaire was also designed to add four portion sizes for each food item, presented as questions, rather than in grid format.Conclusions:Regional food use patterns differ from national patterns and furthermore differ between African American and white adults in the LMD. The resulting Delta NIRI FFQ for Adults should contribute to improved assessment of usual intake for use in studies of diet and health in this region.

Background This study investigated the number of pedometer assessment occasions required to establish habitual physical activity in African American adults. Methods African American adults (mean age 59.9 ± 0.60 years; 59 % female) enrolled in the Diet and Physical Activity Substudy of the Jackson Heart Study wore Yamax pedometers during 3-day monitoring periods, assessed on two to three distinct occasions, each separated by approximately one month. The stability of pedometer measured PA was described as differences in mean steps/day across time, as intraclass correlation coefficients (ICC) by sex, age, and body mass index (BMI) category, and as percent of participants changing steps/day quartiles across time. Results Valid data were obtained for 270 participants on either two or three different assessment occasions. Mean steps/day were not significantly different across assessment occasions (p values > 0.456). The overall ICCs for steps/day assessed on either two or three occasions were 0.57 and 0.76, respectively. In addition, 85 % (two assessment occasions) and 76 % (three assessment occasions) of all participants remained in the same steps/day quartile or changed one quartile over time. Conclusion The current study shows that an overall mean steps/day estimate based on a 3-day monitoring period did not differ significantly over 4 – 6 months. The findings were robust to differences in sex, age, and BMI categories. A single 3-day monitoring period is sufficient to capture habitual physical activity in African American adults.

Total antioxidant performance (TAP) measures antioxidant capacities in both hydrophilic and lipophilic compartments of serum and interactions known to exist between them. Our objective was to assess TAP levels in a subset of Jackson Heart Study (JHS) participants and to examine associations with dietary and total (diet + supplement) intakes of alpha-tocopherol, gamma-tocopherol (diet only), beta-carotene, vitamin C, fruit, vegetables, and nuts, and serum concentrations of alpha-tocopherol, gamma-tocopherol, and beta-carotene. We conducted a cross-sectional analysis of 420 (mean age 61 y; 254 women) African American men and women participating in the Diet and Physical Activity Sub-Study of the JHS in Jackson, Mississippi. In multivariate-adjusted models, we observed positive associations between total alpha-tocopherol, total and dietary beta-carotene, and total vitamin C intakes and TAP levels (P-trend0.05). Positive associations were also observed for vegetable, fruit, and total fruit and vegetable intakes (P-trend0.05). For serum antioxidant nutrients, alpha-tocopherol but not beta-carotene was associated with serum TAP levels. There were inverse associations for serum gamma-tocopherol and TAP levels. Associations for alpha-tocopherol were seen at intake levels much higher than the current Recommended Dietary Allowance. It may, therefore, be prudent to focus on increasing consumption of fruit, vegetables, nuts, and seeds to increase total antioxidant capacity.

Objective To examine the relative validity of two food frequency questionnaires (FFQs) developed for use in investigating diet and disease relationships within the adult African-American population in the southern United States. Design Cross-sectional analyses of dietary nutrient intake data, comparing four 24-hour dietary recalls with an FFQ developed by the Lower Mississippi Delta Nutrition Intervention Research Initiative, and its shorter version adapted for use in the Jackson Heart Study. Subjects A representative subset of participants (n=499, aged 35 to 81 years) from the baseline Jackson Heart Study cohort (N=5,302) was selected for this study. Data collection took place between winter 2000 and spring 2004. Statistical analyses Pearson's correlation coefficients (energy adjusted and de-attenuated) for 26 nutrients estimates from each of the FFQs, comparing them with the mean of four 24-hour dietary recalls. The ability of the FFQs to rank individuals based on nutrient intakes was compared to that of the mean of four 24-hour dietary recalls and attenuation coefficients were also calculated. Results Median nutrient intake estimates tended to be higher on the long and lower on the short FFQ compared to the median for the mean of four 24-hour dietary recalls. Energy adjusted and deattenuated correlations of FFQ intake estimates with recalls ranged from 0.20 for sodium to 0.70 for carbohydrate for the short FFQ and from 0.23 for polyunsaturated fat to 0.75 for dietary fiber and magnesium for the long. Attenuation coefficients for men on average were 0.42 for the short and 0.49 for the long FFQ. For women, these were 0.31 for the short and 0.42 for the long FFQ. Conclusions Both FFQs appear to be reasonably valid for assessment of dietary intake of adult African Americans in the South. The Lower Mississippi Delta Nutrition Intervention Research Initiative FFQ exhibited higher intake estimates and stronger correlations with recalls than the Jackson Heart Study FFQ for most nutrients analyzed, more so for women than men.

Intakes and biochemical concentrations of carotenoids and tocopherols have been associated with chronic diseases.To describe dietary patterns in Jackson Heart Study participants and to determine if biochemical measurements of antioxidants differ across these.Cross-sectional analysis of data for 373 African-American men and women (age 35 to 80 years), participating in the Diet and Physical Activity Substudy of the Jackson Heart Study.Dietary intake was assessed with a region specific food frequency questionnaire. Patterns were defined by cluster analysis of food groups, as percent of energy intake.Four dietary patterns were identified: fast food, Southern, prudent, and juice. Individuals in the fast-food pattern (n=153) had significantly lower serum concentrations of lutein plus zeaxanthin and beta-cryptoxanthin; those in the Southern cluster (n=99) had significantly lower serum alpha-carotene; and those in the prudent (n=63) and juice (n=58) clusters had significantly higher serum alpha-carotene and beta-cryptoxanthin (P0.05) relative to those in at least one other cluster (all P0.05). The juice cluster also had higher serum alpha-tocopherol concentrations relative to the fast-food cluster.Diets high in fast foods, snacks, soft drinks, and meat were associated with relatively low concentrations of carotenoids and alpha-tocopherol. This pattern contained the largest number of participants, and could contribute to the extensive health disparities seen in this region.

Background Recent epidemiologic study results showed that subjects who had high intakes of whole-grain foods had lower risks of death and heart disease than did subjects who had low intakes. However, the findings were inconsistent for fruit and vegetable intake. Objective The relations of whole-grain, refined-grain, and fruit and vegetable intakes with the risk of total mortality and the incidence of coronary artery disease (CAD) and ischemic stroke were studied in the Atherosclerosis Risk in Communities (ARIC) cohort (baseline: age 45-64 y, n = 15,792). Design Proportional hazards regression analyses were used to assess the relations of whole-grain, refined-grain, and fruit and vegetable intakes with the risk of death and the incidence of CAD and ischemic stroke, with adjustment for age, sex, ethnicity, energy intake, and cardiovascular disease risk factors. Dietary intakes were assessed by using a food-frequency questionnaire. Results Over an 11-y follow-up period, whole-grain intake was inversely associated with total mortality and incident CAD. The relative hazards of death for quintiles 2-5 of fruit and vegetable intake were 1.08 (95% CI: 0.88, 1.33), 0.94 (0.75, 1.17), 0.87 (0.68, 1.10), and 0.78 (0.61, 1.01), respectively; P for trend = 0.02. An inverse association between fruit and vegetable intake and CAD was observed among African Americans but not among whites (P for interaction = 0.01). The risk of ischemic stroke was not significantly related to whole-grain, refined-grain, or fruit and vegetable consumption. Conclusion These observational findings suggest a beneficial effect of whole-grain and fruit and vegetable consumption on the risks of total mortality and incident CAD but not on the risk of ischemic stroke.

Despite considerable progress in understanding disease mechanisms and risk factors, improved treatments, and public education efforts, cardiovascular disease (CVD) remains the leading cause of death in the United States. Obesity and physical inactivity, 2 important lifestyle-related risk factors for CVD, are prevalent in the southeastern United States and are becoming more prevalent in all racial groups and areas of the country. In reviewing these risk factors, we explored topics including prevalence and trends in population data; associated psychosocial and environmental factors; and some of the mechanisms through which these risk factors are thought to contribute to CVD. We identified significant, but as yet poorly understood, racial disparities in prevalence of obesity, low levels of physical activity, and correlates of these risk factors and examined important differences in the complex relationship between obesity, diabetes, and cardiovascular disease risk between African American and European American women. The Jackson Heart Study will provide important and unique information relevant to many unanswered questions about obesity, physical inactivity, and obesity in African Americans.

This investigation was conducted to determine the mortality rate due to drownings in Mississippi from 1992-1994. Drownings were defined as unintentional deaths from asphyxia while submerged or within 24 hours of submersion. Death certificate data including ICD-9 codes related to drownings, were received from the Mississippi State Department of Health. Variables assessed included age, age category, sex, race, death month, death day, place of drowning, and risk factors. Although drownings occurred in ages from 0-91 years, the highest mortality rates were found in the 14-17 year old age category (1 1.9 deaths per 100,000). Asian and Native American populations had the highest drowning mortality rates (23.6 and 22.6 per 100,000) when analyzed by race. However, this may be primarily due to lower populations. Males drowned five times more frequently than women. This is felt to be related to increased exposure. More drownings occurred on Saturdays and Sundays; and in the months of July, June; May, April, September, and August consecutively. Results presented here identify correlates of drowning fatalities which will enable strategic targeting of prevention programs and resources.

The importance of nutrition in health maintenance, disease prevention and treatment is well documented. The Human Genome Project and additional genetic research have confirmed that considerable genetic variability exists between individuals with the same disease. Even individuals with the same genotypes demonstrate clinical heterogeneity, because both environmental and genetic factors determine the clinical presentation, prognosis and course. Individualization of medical nutrition therapy (MNT) is the recommended approach. An inborn error of metabolism model will demonstrate how genetic information may impact on dietetic practice. Data will be presented describing variability in biochemical tolerance of patients with galactose-1-phosphate uridyltransferase-deficient galactosemia. Correlations between molecular genotypes and phenotypes with biochemical tolerance will be presented. This model is used to elucidate implications for future clinical practice. Multi-factorial diseases such as diabetes, hyperlipidemias, osteoporosis, etc. which affect large populations may eventually require review of an individual's molecular studies prior to the provision of MNT. Future provision of MNT will require a greater understanding of basic genetic principles including molecular and biochemical concepts. Enhanced knowledge of genetics, will enable nutrition professionals to have an optimal impact on the health of patients, families and sub-populations they serve.

LEARNING OUTCOME: To identify training, and reimbursement mechanisms available to nutrition personnel serving genetics patients. The Nutrition Management Committee of the Southeastern Regional Genetics Group (SERGG) conducted a national survey of 157 nutritionists involved in providing nutrition services to individuals with genetic disorders treated by dietary intervention. The purpose of this survey was to identify and characterize the level of clinical expertise, professional roles, reimbursement strategies, and future education needs of these professionals. The response rate was 57% (n=89). Of these, 99% were registered dietitians and 40% had state licensure. Although final degrees ranged from bachelor to doctorate degrees, the majority (62%) had master degrees and 21% had advanced certification in a specialty area. The respondents' roles were equally divided between acute and long-term care. Direct reimbursement was received by only 18%; 35% received indirect reimbursement and 26% participated in a packaged reimbursement system for nutrition services. Direct encounters (face-to-face procedures) were billed by half of those surveyed. Indirect encounters (non-face-to-face procedures) were felt to be of equal importance, especially for follow-up and monitoring. However, few reported reimbursement for indirect encounters, indicating a need for greater awareness of the crucial role of the nutritionist in the prevention of morbidity and mortality in many genetic disorders. Survey results documented the nutritionists' perceived need for further education in a variety of forms. The majority expressed the need for short-term training (no more than 1-2 weeks) due to demanding work schedules. The results of this survey document the important role of the specialized nutritionist in the field of genetics, and the desire among this group of professionals for more educational and reimbursement opportunities.

National leaders in maternal and child health have recommended that nutrition services for children with special health care needs be culturally sensitive, family centered, and community based, and that families of children served be included in all levels of service development, implementation, and evaluation. The purpose of this research was to identify needs for nutrition services and nutrition education resources, as perceived by parents of children with special health care needs. Needs were assessed using the focus group technique, a qualitative research method that has been used for health promotion and nutrition education needs assessment in a variety of settings with various population groups. Focus groups were conducted with parents in three of four Children's Medical Program (CMP) regions of a southeastern state. Parents were invited to participate in the focus groups through region-specific mailings to families of children receiving services through the CMP or through notification in a parent support group newsletter. Four focus groups ranging in size from four to six parents were conducted. The groups were representative of the racial diversity and the variety of disabilities and chronic illnesses included in the population of children served by the CMP. Conditions represented included phenylketonuria, galactosemia, Down syndrome, cerebral palsy, spina bifida, cleft Up/palate, and others. Focus group sessions were conducted by a social worker and a dietitian trained in the technique, and were recorded on audiotape. Tapes were transcribed following the sessions, and reviewed to identify common themes. Nutrition education needs identified included: need for information on reading food labels to determine if a particular food is appropriate for the child's dietary restrictions and for information on meal planning to address the family's nutritional needs as well as the specific needs of the chfld. Nutrition service needs included: need for more service delivery and follow-up care at the local level; need for assistance in working with school foodservice to meet child's special nutritional needs in the school setting. Parents are an important source of information about nutrition-related needs of children with chronic illnesses and disabilities. The focus group technique can be used to seek their input as a basis for development of programs, services, and educational materials.

Dietitians must be responsive to the changing needs of their clients and employers, to societal concerns, and to legal mandates. A recently passed amendment (PL 99-457) to the Federal Education for the Handicapped Act gives nutrition professionals the opportunity to have a voice in establishing nutrition policy and standards of care for young handicapped and high-risk children. The new law extends preventive services to children as young as 3 years of age, and Part H of the law provides financial incentives for states to provide services to children with special health care needs from birth to 2 years of age. This article reviews relevant provisions of the new law and describes two projects undertaken by nutritionists from Alabama, Mississippi, and Texas. It also summarizes challenges to nutritionists that will result from the law’s implementation. J Am Diet Assoc 89:1636-1639, 1989.

Dietitians must be responsive to the changing needs of their clients and employers, to societal concerns, and to legal mandates. A recently passed amendment (PL 99-457) to the Federal Education for the Handicapped Act gives nutrition professionals the opportunity to have a voice in establishing nutrition policy and standards of care for young handicapped and high-risk children. The new law extends preventive services to children as young as 3 years of age, and Part H of the law provides financial incentives for states to provide services to children with special health care needs from birth to 2 years of age. This article reviews relevant provisions of the new law and describes two projects undertaken by nutritionists from Alabama, Mississippi, and Texas. It also summarizes challenges to nutritionists that will result from the law's implementation.