Significant Changes In Dietary Intake Research Articles

Nutritional Intervention Improves the Dietary Intake of Essential Micronutrients in Patients with Diabetic Foot Ulcers

Abstract Objectives Diabetic foot ulcer (DFU) is a chronic wound and a common cause of lower limb amputation. A majority of DFU patients are suffering from undernutrition or malnutrition. The purpose of this randomized trial was to evaluate the combined effects of complete nutrition supplementation and education on the dietary intake of DFU patients. Methods A total of 29 patients with at least one grade 1 A foot ulcer based on the University of Texas Diabetic Wound Classification were assigned to the treatment or control. Aside from the standard of care for DFU, participants in the treatment group were provided with a dietary supplement twice a day between meals and were educated about consuming better food sources of essential nutrients for wound healing. The supplement provided 500 kcal of energy and at least 50% of RDA recommendations for protein, vitamin C, E, A, zinc, and copper. Participants in the control group only received standard of care for wound healing from the clinic. Dietary intake data were recorded at baseline and every four weeks up to 12 weeks or until the complete wound closure using 24-hour food recall questionnaire. Results The mean age of the study population was 53.3 ± 11.1 years. There were no significant differences in age, ethnicity, body mass index, hemoglobin A1C, duration of diabetes, wound age estimation, indicators of socioeconomic status and other factors involved in dietary intake including cultural and religious dietary restrictions, appetite problems, and previous unintentional weight loss between groups at baseline. Having routine visits with a registered dietitian was not part of the standard care for this population. When compared with RDA, dietary intake of zinc (33.2% to 89.2%, P = 0.02), copper (26% to 114%, P < 0.001), vitamins A (30.6 to 72.9, P = 0.001), C (117% to 403%, P = < 0.001), and E (7.29% to 306%, P = < 0.001) was significantly improved in the treatment group during the study period but there were no significant changes in dietary intake of protein or energy. There were also no significant changes in the dietary intake of the mentioned nutrients in the control group. Conclusions Our findings showed that the dietary intake of essential nutrients in wound healing was alarmingly low in DFU patients. Hence, nutritional intervention is essential and should be a part of routine care in this population. Funding Sources Florida State University.

The effects of 6 mo of supplementation with probiotics and synbiotics on gut microbiota in the adults with prediabetes: A double blind randomized clinical trial.

The evidence of 16S rRNA genes in the gut microbiota distinguished a higher Firmicutes-to-Bacteroidetes ratio in individuals who were obese and had diabetes than in a healthy cohort. So, it seems that the modulation of intestinal microbial ecology by pro-/pre-/synbiotics may contribute to the progression and prevention of metabolic diseases. The aim of this study was to assess the effects of probiotics and synbiotic supplementation on the modification of the intestinal microbiome in adults with prediabetes. In a randomized, double-blinded, placebo-controlled clinical trial, 120 patients with prediabetes were randomly assigned to consume 6 g/d of either a placebo containing maltodextrin (control) or multispecies probiotic or inulin-based synbiotic for 6 mo. Fecal samples were obtained at baseline and after 6 mo of supplementation. Dietary intake was assessed throughout the study (at baseline and after 3 and 6 mo). Total energy, macronutrients, and dietary fiber were calculated using a dietary program Nutritionist 4. DNA was extracted from fecal samples and the numbers of Clostridium perfringens (the represent of phylum Firmicutes), Bacteroides fragilis (the representative of Bacteroidetes) and Escherichia coli (as universal bacteria) were determined by quantitative real-time polymerase chain reactions (qPCR). The changes in the relative abundance of the two fecal bacteria before and after supplementation were analyzed and compared within and between groups. There were no significant changes in dietary intake during the study. Six mo of supplementation with probiotics resulted in a statistically significant increase in the abundance of the B. fragilis-to-E.coli ratio (mean difference [MD] ± SE 0.47 ± 0.37, P=0.04) and decrease of the relative proportion of Firmicutes-to-Bacteroidetes representatives (MD ± SE -118.8 ± 114.6, P=0.02). Synbiotic had no significant effect on the changes in the bacteria. There were no significant differences between the three groups. The results of this study suggest that manipulation of the human gut microbiome by using probiotics could provide a potential therapeutic approach in the prevention and management of obesity and metabolic disorders such as diabetes.

207P - Significant changes in dietary intake and physical activity after breast cancer diagnosis in a Chinese breast cancer cohort study

Background: The diagnosis of cancer can motivate survivors to modify lifestyles, typically involving diet and physical activity. Few data have reported pre- and post-diagnostic lifestyle habits in Chinese population. Methods: In an on-going prospective cohort study which involved 1462 Chinese women with early-stage breast cancer, we evaluated dietary intake and lifestyle factors pre- and post- breast cancer diagnosis. Validated food frequency questionnaires were used to evaluate dietary intake. Leisure time physical activity was measured by a modified Chinese Baecke questionnaire. This report compared changes of dietary intake and physical activity between 12 months before and 18 months after diagnosis of breast cancer. Results: Intake of whole grains, refined grains, fruits, vegetables, eggs, and nuts increased significantly post-diagnosis (Range, 54%-72% increase; P < 0.001, each; Table). Conversely, after diagnosis consumption of red meat, processed meat, poultry, dairy products, soy, sugar drinks, and coffee significantly decreased (Range, 32%-63% decrease; P < 0.001, each). The level of physical activity (MET-hour per week) post-diagnosis was significantly increased (median, 0.75 vs. 5.25; P < 0.001), with 58% of patients became more physically active. However, the proportion of women that met the WCRF/AICR Cancer Prevention recommendations about physical activity (10 MET-hour per week) was still low, only 21% women met at pre-diagnosis, increasing to 34% at post-diagnosis.Table207PFood groupPre-diagnosis [Median (IQR), g/1000kcal/day]Pre-diagnosis [Median (IQR), g/1000kcal/day]Refined grains269.9 (213.3-348.3)319.6 (257.8-391.2)Whole grains3.6 (0-11.9)7.4 (0.7-30.0)Fruits95.1 (54.3-137.8)140.4 (92.0-193.6)Vegetables194.1 (136.8-263.2)271.5 (197.3-359.8)Eggs8.3 (4.1-14.8)10.1 (5.2-16.9)Red meat48.3 (29.1-72.7)38.2 (20.3-62.0)Processed meat1.7 (0.3-4.8)0.4 (0-2.4)Poultry20.4 (9.6-38.2)1.1 (0-7.1)Dairy products15.4 (5.0-44.5)5.7 (0.6-15.9)Soy28.1 (12.8-55.1)23.3 (8.3-49.0)*IQR, inter quartile range. Open table in a new tab *IQR, inter quartile range. Conclusions: In this cohort study, Chinese breast cancer patients reported significant changes in dietary intake and increased physical activity level and a higher proportion met the WCRF/AICR Cancer Prevention recommendations after cancer diagnosis. These findings provided crucial information on lifestyle behaviors in Chinese breast cancer survivors, and provided information to healthcare professionals on survivors’ health and quality of life. Legal entity responsible for the study: The Chinese University of Hong Kong Funding: World Cancer Research Fund International (Grant Number WCRF 2010/249 and WCRF 2014/1197). Disclosure: All authors have declared no conflicts of interest.

A Systematic Review of the Impact of Multi-Strategy Nutrition Education Programs on Health and Nutrition of Adolescents

ObjectiveTo update evidence on the impact of multi-strategy nutrition education interventions on adolescents' health and nutrition outcomes and behaviors. DesignSystematic review of randomized controlled studies of multi-strategy interventions encompassing nutrition education published from 2000 to 2014 guided by the Preferred Reported Items for Systematic Reviews and Meta-analyses statement. SettingSecondary schools in developed countries. ParticipantsAdolescents aged 10–18 years. Main Outcome MeasuresAnthropometric and dietary intake. AnalysisSystematic search of 7,009 unduplicated articles and review of 11 studies (13 articles) meeting inclusion criteria using qualitative comparison. ResultsFour studies reported significant changes in anthropometric measures and 9 showed significant changes in dietary intake. Type of nutrition education varied. Components of the interventions that showed statistically significant changes in anthropometric and dietary intake included facilitation of the programs by school staff and teachers, parental involvement, and using theoretical models to guide the intervention's development. Changes in canteens, food supply, and vending machines were associated with significant changes in dietary intake. Conclusions and ImplicationsMulti-strategy interventions can have significant impacts on nutrition of adolescents when the nutrition education is theoretically based and facilitated by school staff in conjunction with parents and families, and includes changes to the school food environment.

The Effects of Enrolling in a Nutrition Class on Dietary Intake for Whittier College Students

BackgroundDietary modification is an important component to any public health strategy aimed at combatting obesity. Nutrition education is used for dietary modification as subjects obtain more knowledge about food and its nutritional content. Several nutrition education programs have led to healthier food choices. The purpose of this study was to assess the impact of enrolling in an introductory nutrition course at Whittier College on food choices.MethodsProspective three‐month study with 23 students from Whittier College (males = 8, females = 15) who were enrolled in an introductory nutrition course. A validated food frequency questionnaire from the University of Arizona was administered at baseline and at the three month follow‐up to assess any significant changes in dietary intake. The results from the frequency questionnaires were sent to the University of Arizona Diet, Behavior, and Quality of Life Assessment Lab to analyze macronutrient and micronutrient intake. Paired t‐tests were used to calculate mean differences (meand) and non‐parametric alternatives were used to calculate median differences (medd) between baseline and 3 month follow‐up on dietary intake and physical activity.ResultsThere was a significant reduction in caloric intake (meand=−22.31%, p=0.04), alcohol intake (meand=−3.4%, p=0.01), total fatty acid intake (meand=−24.69%, 0.03), saturated fatty intake (meand=−22.44%, p=0.03), and Trans fatty acid intake (meand=−23.5%, p=0.06). Total body weight and BMI were not significantly altered (medd @ 0, p=0.2471; medd @ 0, p=0.1311), respectively.ConclusionWhittier College students enrolled in a nutrition course showed significant decreases in their total fatty acid intake, but notably, their saturated fatty acid and Trans fatty acid intake were reduced. These reported changes may relate to the improvement of healthier food choices as a result of the students’ enrollment in a nutrition course that improved their self‐care

A novel dietary improvement strategy: examining the potential impact of community-supported agriculture membership.

To investigate the use of community-supported agriculture (CSA) as an employer-based health promotion intervention. Quasi-experimental study using a convenience sample of employees at three employers. Participants and controls from three Minnesota employers completed baseline and follow-up health assessments and surveys about their experiences with CSA. A total of 324 participants purchased a CSA share and were eligible for study inclusion. Study participants were matched by age, sex, employer and occupation to a non-randomized control group of individuals who did not purchase a CSA share but completed health assessments during the same time frame as the study participants. The majority of participants were female, white, middle-aged and highly educated. The most common reason for purchasing a CSA share was a desire for fresh food, and the majority of participants were satisfied with their experience. Participants reported a significant increase in the number of vegetables present in the household and the frequency of family meals. The frequency of eating out decreased significantly, especially at fast-food restaurants. Participants also reported an increase in the amount and variety of produce consumed. However, health assessment data did not show significant changes in dietary intake, health status or BMI. CSA participation was associated with improvement in some aspects of the household environment and dietary behaviours. Further research is needed to determine whether employer-based CSA interventions may also lead to improvements in dietary intake and health.

The effects of increased dietary fiber intake on the self-reported quality of life of school-age children

The aim of this community-based, randomized-controlled prospective nutrition intervention study was to assess the impact of serving high-fiber snacks twice a day to a sample of school-age children on their dietary fiber intake and health-related quality of life (HRQOL) scores. Participants (n = 81) were children aged 7-11 years. Children were randomized to receive two high-fiber snacks per day for eight weeks (intervention) or to continue eating their regular snacks (control). At baseline and post-intervention, usual dietary intake data were collected via repeated 24-hour dietary recalls and HRQOL was assessed using the PedsQL? Pediatric Quality of Life Inventory. Statistical analysis to assess significant changes in dietary intake as well as self-reported quality of life was conducted using two-sided student’s t-tests; significance level was set at p to elementary-school children can effectively increase dietary fiber consumption and may lead to an improved physical quality of life. Further research is needed regarding the impact of nutrition on health-related quality of life.

Participation in mindfulness-based stress reduction is not associated with reductions in emotional eating or uncontrolled eating

The adverse health effects and increasing prevalence of obesity in the United States make interventions for obesity a priority in health research. Diet-focused interventions generally do not result in lasting reductions in weight. Behavioral interventions that increase awareness of eating cues and satiety have been postulated to result in healthier eating habits. We hypothesized that participation in a program called mindfulness-based stress reduction (MBSR) would positively influence the eating behaviors and nutritional intake of participants through changes in emotional eating (EE), uncontrolled eating (UE), and type and quantity of food consumed. Forty-eight veterans at a large urban Veterans Administration medical center were assessed before MBSR, after MBSR, and 4 months later. For all participants (N = 48), MBSR participation was not associated with significant changes in EE or UE. In addition, there were no significant differences in the intake of energy, fat, sugar, fruit, or vegetables at either follow-up time point as compared with baseline. Enhanced mindfulness skills and reduced depressive symptoms were seen over time with medium to large effect sizes. Changes in mindfulness skills were significantly and negatively correlated with changes in EE and UE over time. Overall, there was no evidence that participation in MBSR was associated with beneficial changes in eating through reductions in disinhibited eating or significant changes in dietary intake. Randomized studies are needed to further define the relationship between mindfulness program participation and eating behaviors.

Baby-led weaning and the family diet. A pilot study

Baby-led weaning (BLW) is a style of solid food introduction that emphasizes self-feeding rather than spoon-feeding. The purpose of this cross-sectional study was to determine whether parents using BLW change their dietary intake during weaning, and if their babies are offered family foods. Participants kept diet diaries at baseline and three months later, post-BLW implementation. Wilcoxon tests revealed no significant changes in dietary intake during the first three months of weaning, however, parents offered their children 57% of the same foods they were consuming. Results suggest that BLW does not lead to dietary changes among parents during the weaning process.

Significant changes in dietary intake and supplement use after breast cancer diagnosis in a UK multicentre study

The diagnosis of cancer can motivate survivors to alter their lifestyle habits. Healthcare providers need to be aware of what changes patients are likely to make in order to derive more pertinent recommendations; however, few studies have reported pre- and post-diagnostic lifestyle behaviours. Semi-quantitative food frequency questionnaires (FFQs) completed approximately 1 year after diagnosis were used to evaluate dietary intake and supplement use before and after diagnosis in a cohort of 1,560 breast cancer patients participating in the UK, prospective DietCompLyf study. Intake of fruit and vegetables, wholegrains and lean sources of protein increased significantly post-diagnosis (P < 0.05, each). Conversely, after diagnosis consumption of high-fat, high-sugar products, red meat, coffee, some alcoholic drinks and refined grains significantly decreased (P < 0.05, each). Post-diagnostic changes in diet were accompanied by changes in the intake of macronutrients and a number of vitamins and minerals. Supplement use was highly prevalent (56.1%) pre-diagnosis, increasing to 62.8% after diagnosis (P = 0.001). Fish oils, multivitamin and minerals, and evening primrose oil were most often used and the proportion of users significantly increased (P < 0.05, each) after diagnosis. The percentage of women using oestrogenic botanical supplements (OBSs) was small but more than doubled to 8.4% after diagnosis (P < 0.05). British women participating in the DietCompLyf study reported significant changes in dietary intake and supplement use after their breast cancer diagnosis. These findings contribute to our understanding of female cancer survivors' dietary behaviours which is crucial for developing and implementing recommendations.

Significant changes in dietary intake and supplement use after breast cancer diagnosis in a UK prospective multicentre study

Significant changes in dietary intake and supplement use after breast cancer diagnosis in a UK prospective multicentre study

Use of a renal-specific oral supplement by haemodialysis patients with low protein intake does not increase the need for phosphate binders and may prevent a decline in nutritional status and quality of life

Protein-energy wasting is a frequent and debilitating condition in maintenance dialysis. We randomly tested if an energy-dense, phosphate-restricted, renal-specific oral supplement could maintain adequate nutritional intake and prevent malnutrition in maintenance haemodialysis patients with insufficient intake. Eighty-six patients were assigned to a standard care (CTRL) group or were prescribed two 125-ml packs of Renilon 7.5(R) daily for 3 months (SUPP). Dietary intake, serum (S) albumin, prealbumin, protein nitrogen appearance (nPNA), C-reactive protein, subjective global assessment (SGA) and quality of life (QOL) were recorded at baseline and after 3 months. While intention to treat analysis (ITT) did not reveal strong statistically significant changes in dietary intake between groups, per protocol (PP) analysis showed that the SUPP group increased protein (P < 0.01) and energy (P < 0.01) intakes. In contrast, protein and energy intakes further deteriorated in the CTRL group (PP). Although there was no difference in serum albumin and prealbumin changes between groups, in the total population serum albumin and prealbumin changes were positively associated with the increment in protein intake (r = 0.29, P = 0.01 and r = 0.27, P = 0.02, respectively). The SUPP group did not increase phosphate intake, phosphataemia remained unaffected, and the use of phosphate binders remained stable or decreased. The SUPP group exhibited improved SGA and QOL (P < 0.05). This study shows that providing maintenance haemodialysis patients with insufficient intake with a renal-specific oral supplement may prevent deterioration in nutritional indices and QOL without increasing the need for phosphate binders.

Relationships between adipose tissue and cytokine responses to a randomized controlled exercise training intervention

Adipose-derived cytokines play a prominent role in mediating the metabolic consequences of obesity and excess body fat. Given this, we hypothesized that alterations in adipose tissue stores incurred with exercise training would be reflected in changes in systemic cytokine concentrations. The Studies of Targeted Risk Reduction Intervention through Defined Exercise, where pronounced changes in adipose tissue stores were observed in the absence of significant changes in dietary intake, provided an ideal setting in which to test this hypothesis. Participants were randomized to 6 months of inactivity or one of 3 types of aerobic exercise training regimens: low-amount-moderate-intensity, low-amount-vigorous-intensity, and high-amount-vigorous-intensity. Plasma samples were collected at baseline and 2 weeks after cessation of 6 months of exercise training or inactivity. In 189 participants, concentrations of 17 cytokines were measured using Bio-Plex Cytokine Assays (Bio-Rad, Hercules, CA); 10 additional cytokines were measured in 60 of these subjects. Of all cytokines tested, the only concentration changes that approached statistical significance were those for granulocyte monocyte–colony stimulating factor and vascular endothelial growth factor, which appeared to increase with training in the low-amount-high-intensity group only ( P < .05 for both cytokines). No response to exercise training was noted for any additional cytokine in any of the groups. No relationships were observed between changes in cytokine concentrations and changes in fat mass or other measures of body habitus. In contradiction to our hypothesis, despite significant alterations in body composition, exercise training produced limited cytokine responses.

Effect of Group Racial Composition on Weight Loss in African Americans

We do not know how racial composition of a group influences behavior change for African Americans (AAs) in group-based weight loss programs. We tested the hypothesis that AA who participate in all AA weight loss intervention groups will lose more weight than AA who participate in mixed race groups. This observational study was ancillary to Phase 1 of the Weight Loss Maintenance Study, a multi-center trial of strategies to maintain weight loss after a 20-week behavior modification program. Three of four centers recruited several all-AA intervention groups. Remaining groups were combinations of AA and non-AA participants. All participants received the same weight loss intervention. Change in weight was the primary outcome, comparing participants of all-AA groups with AA participants of mixed race groups conducted by the same AA interventionists. Secondary outcomes included measures of intervention adherence and behavior change. Participants of all-AA groups (n = 271) were comparable to other AA participants (n = 106). The mean proportion of AA in mixed race groups was 56%. All-AA group participants had similar weight loss as those in mixed groups (-4.2 vs. -4.2 kg, P = 0.97). There were no differences between the groups in mean number of sessions attended or changes in dietary intake. Significant weight loss was observed in both groups, with no effect of group composition on adherence or weight loss outcomes. Special logistics to accommodate all-AA groups may not be necessary. Despite varying instructional environments, AA appeared to respond positively to intervention messages with significant changes in dietary intake, physical activity (PA), and weight.

Energy balance in early breast cancer patients receiving adjuvant chemotherapy.

Weight gain is a common problem amongst women receiving adjuvant chemotherapy for early breast cancer. We undertook a study to determine the causes of this weight gain. Prospective measurements of body mass and composition (skinfolds, bioelectrical impedance, total body potassium), energy balance (resting energy expenditure dietary intake, and physical activity), were determined in 17 women during and in the 6 months after commencing adjuvant chemotherapy. Women gained significant amounts of weight (5.0 +/- 3.8; p < 0.01) and body fat (7.1 kg +/- 4.5; p < 0.01) over the year. Waist circumference (5.1 +/- 4.5 cm; p < 0.01) and abdominal skinfold (16.2 +/- 10 mm; p < 0.01) were also increased but there was a decline in fat free mass (FFM); 1.7 +/- 2.5 kg. Women due to receive adjuvant chemotherapy had a greater resting energy expenditure (REE) compared with healthy subjects (n = 21); 100.5 +/- 8.0% Harris Benedict compared to 94.5 +/- 8.4% Harris Benedict (p = 0.05). REE declined by 3% during adjuvant chemotherapy (p < 0.05), and remained depressed until at least 3 months posttreatment. There were no significant changes in dietary intake or physical activity over the year. Failure of women to reduce their energy intake to compensate for the decreased energy requirement may account for some of the weight gain. Treatment of adjuvant chemotherapy causes gain of body fat because of reduced energy expenditure, and the failure of women to reduce their energy intake to compensate for the decline in energy requirement during and in the 6 months posttreatment. Since weight gain impacts on survival, patients should be counselled to reduce energy intake and exercise during and after adjuvant treatment.

Effects of the Amount of Exercise on Body Weight, Body Composition, and Measures of Central Obesity

Obesity is a major health problem due, in part, to physical inactivity. The amount of activity needed to prevent weight gain is unknown. To determine the effects of different amounts and intensities of exercise training. Randomized controlled trial (February 1999-July 2002). Sedentary, overweight men and women (aged 40-65 years) with mild to moderate dyslipidemia were recruited from Durham, NC, and surrounding communities. Eight-month exercise program with 3 groups: (1) high amount/vigorous intensity (calorically equivalent to approximately 20 miles [32.0 km] of jogging per week at 65%-80% peak oxygen consumption); (2) low amount/vigorous intensity (equivalent to approximately 12 miles [19.2 km] of jogging per week at 65%-80%), and (3) low amount/moderate intensity (equivalent to approximately 12 miles [19.2 km] of walking per week at 40%-55%). Subjects were counseled not to change their diet and were encouraged to maintain body weight. Body weight, body composition (via skinfolds), and waist circumference. Of 302 subjects screened, 182 met criteria and were randomized and 120 completed the study. There was a significant (P<.05) dose-response relationship between amount of exercise and amount of weight loss and fat mass loss. The high-amount/vigorous-intensity group lost significantly more body mass (in mean [SD] kilograms) and fat mass (in mean [SD] kilograms) (-2.9 [2.8] and -4.8 [3.0], respectively) than the low-amount/moderate-intensity group (-0.9 [1.8] and -2.0 [2.6], respectively), the low-amount/vigorous-intensity group (-0.6 [2.0] and -2.5 [3.4], respectively), and the controls (+1.0 [2.1] and +0.4 [3.0], respectively). Both low-amount groups had significantly greater improvements than controls but were not different from each other. Compared with controls, all exercise groups significantly decreased abdominal, minimal waist, and hip circumference measurements. There were no significant changes in dietary intake for any group. In nondieting, overweight subjects, the controls gained weight, both low-amount exercise groups lost weight and fat, and the high-amount group lost more of each in a dose-response manner. These findings strongly suggest that, absent changes in diet, a higher amount of activity is necessary for weight maintenance and that the positive caloric imbalance observed in the overweight controls is small and can be reversed by a modest amount of exercise. Most individuals can accomplish this by walking 30 minutes every day.

Multivitamin/Mineral Supplementation Improves Plasma B-Vitamin Status and Homocysteine Concentration in Healthy Older Adults Consuming a Folate-Fortified Diet

Elevated homocysteine has been identified as an independent risk factor for cardiovascular and cerebrovascular disease. Although multivitamin use has been associated with low plasma homocysteine concentrations in several observational studies, no clinical trials have been conducted using multivitamin/mineral supplements to lower homocysteine. We determined whether a multivitamin/mineral supplement formulated at about 100% Daily Value will further lower homocysteine concentration and improve B-vitamin status in healthy older adults already consuming a diet fortified with folic acid. In this randomized, double-blind, placebo-controlled trial, 80 free-living men and women aged 50-87 y with total plasma homocysteine concentrations of > or =8 micromol/L received either a multivitamin/mineral supplement or placebo for 56 d while consuming their usual diet. After the 8-wk treatment, subjects taking the supplement had significantly higher B-vitamin status and lower homocysteine concentration than controls (P: < 0.01). Plasma folate, pyridoxal phosphate (PLP) and vitamin B-12 concentrations were increased 41.6, 36.5 and 13.8%, respectively, in the supplemented group, whereas no changes were observed in the placebo group. The mean homocysteine concentration decreased 9.6% in the supplemented group (P: < 0.001) and was unaffected in the placebo group. There were no significant changes in dietary intake during the intervention. Multivitamin/mineral supplementation can improve B-vitamin status and reduce plasma homocysteine concentration in older adults already consuming a folate-fortified diet.

The Role of Self-efficacy in Improving Dietary Behaviors for Reduction of Nutrition-related Cancers

The effect of dietary self-efficacy on nutrient intake to reduce risk of cancer was studied in a prospective quasi- experimental design. It is estimated that an average of 35% of cancer deaths may be related to diet. Self-efficacy, a construct in social learning theory, may serve as a basis for the identification of methods to enhance healthy eating behaviors. Self-efficacy suggests that conviction in an ability to perform a skill determines which behaviors a person will engage in, how he or she will endure, and how much effort he or she will employ to achieve personal goals. Eat for Life, a nutrition and cancer prevention program, was developed to enhance one's self-efficacy by promoting positive outcome expectations, by providing clear dietary messages and encouraging participants to attempt small steps towards changes in eating habits. A self-efficacy questionaire was developed and pre-tested with a resulting coefficient reliability of 0.71±03 (baseline, pre-test, two post-tests). It measured three constructs: skills, integration of cognitive, personal and skill beliefs, and confidence. Subjects (n=82) were recruited from promotional fliers and media coverage and randomized into four groups. They participated in a three part educational series. Each program session was designed to build upon the skills and knowledge of the preceding class. Prior to the intervention and at one week and six months post-intervention subjects completed four day food diaries and self-efficacy questionnaires. Self-efficacy increased from the pre-test to both post-tests 17% (p<05). There were significant changes in dietary intake; a decrease in percentage of calories from fat (12%), and fat intake (12%). Fiber intake improved 24% (p<05) and servings of fruit 45% (p<01).At the second posttest, our study group's dietary patterns were significantly healthier than their national counterparts. The findings of this study are supportive of the hypothesis that dietary self-efficacy improves as a result of the hands-on intervention based on behavioral theory.