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Late hyponatremia in very low birthweight infants: incidence and associated risk factors
MONDAY, OCTOBER 17 ORIGINAL CONTRIBUTIONS: YEAR 2000 HEALTH OBJECTIVES LATE HYPONATREMIA IN VERY LOW BIRTHWEIGHT INFANTS: INCIDENCE AND ASSOCIATED RISK FACTORS. LL. Kloiber, MS, RD, NJ. Winn, MS, RD, S.G. Shaffer, MD, R.E. Wheeler, MS, RD. Department of Dietetics & Nutrition, University of Kansas Medical Center, Kansas City, KS and Saint Luke's Hospital Perinatal Center, Kansas City, MO. The purpose of this study was to determine the incidence of late hyponatremia (LH) in very low birthweight (VLBW) infants and to identify associated demographic, growth and nutrition, and clinical variables. These determinations were made by means of a retrospective chart review of VLBW infants. Ninety-six subjects included a) 60 VLBW infants who developed LH and b) 36 VLBW infants who did not develop LH. The average age at which LH was diagnosed was 24 days. Statistically significant differences were found between the LH and "no LH (NLH) subjects in birthweight (p<0.001), gestational age (p<0.001), type of feeding (p<0.05), protein intake (p<0.01), sodium intake (p<0.01), and duration of mechanical ventilation (p<0.05). Thirty-six (60%) subjects in the LH group had birthweights < 1000g, while only 4 (11%) in the NLH group had birthweights that low. There were 42 subjects with a gestational age < 28 week and 37 (88%) developed LH. Of 34 subjects who received fortified human milk (FHM) exclusively, 27 (80%) developed LH. The non-stepwise multiple logistic regression established three potential predictors of LH: birthweight (1000g), type of feeding (FHM) and the occurrence of intraventricular hemorrhage (IVH). The probability of LH increased with any addition of FHM despite birthweight. The finding of an association between LH and IVH is not explained by the pathological mechanism following IVH and may be spurious. However, this association underscores the need to differentiate between pathologic and nutritional etiologies associated with LH in order to initiate appropriate treatment. Since type of feeding is a risk factor that can be easily manipulated it appears prudent to increase the sodium intake for VLBW infants receiving FHM, especially if birthweight is < 1000g.
SELF-EFFICACY FOR FRUIT AND VEGETABLE CONSUMPTION AMONG 4TH AND 5TH GRADERS: RELIABILITY AND VALIDITY. S.B. Domel, PhD,RD,LD, W.O. Thompson, PhD, S.B. Leonard, MS,RD,LD, and J. Baranowski, MPH,RD,LD, Medical College of Georgia, Georgia Prevention Institute, Augusta, GA Most American adults and children eat fewer servings of fruits and vegetables (F&V) than the Year 2000 goal of 5 or more a day. Eating is a behavior; self-efficacy concerns the beliefs a person has about how able s/he is of performing a particular behavior In particular situations. Bandura proposed that behavior change will occur only when the person has a substantial level of self-efficacy, or confidence, for the new behavior. The purpose of this study was to develop, pilot-test, and field-apply a self-efficacy questionnaire regarding F&V consumption among 4th and 5th grade students. This study was part of a larger study concerning an Intervention to promote F&V consumption among students this age. The sample included 392 students with 140 from one school for pilot-testing and 252 from two schools for field application; subjects were primarily African American or white, non-Hispanic. The questionnaire included 34 items generated by inventorying behaviors targeted for change In the F&V school curriculum. Principal components analysis ndicated 4 subscales (after-school F&V snacks; breakfast and lunch F&V, and paying for F&V; independent shopping for F&V; and assisted shopping for F&V) accounting for 43.8% of the total variance. Means for the "assisted shopping for F&V" subscale were higher than the other three subscale means regardless of gender, grade, and ethnicity. Subscale test-retest reliabilities (Pearson productmoment correlations) within school ranged from .39 to .65; subscale internal consistencies (Cronbach's alpha coefficient) within schools ranged from .71 to .86. Pearson correlation coefficients between F&V self-efficacy subscales and F&V consumption (from food records) were low (-.02 to .17). Correlation coefficients for the F&V self-efficacy subscales were higher with F&V preferences (.03 to .49) and F&V outcome expectations (.02 to .25) than with F&V consumption. Further research concerning children's F&V selfefficacy must be placed within a broader context which considers the extent to which children control factors effecting F&V availability.
5 A DAY FOR BETTER HEALTH AMONG COLLEGE STUDENTS. L.L. Ebro, PhD, RD, LD, R. Plato-Wilbum, MS, RD, LD and B.H. Kopel, EdD, RD, LD, College ofHuman Environmental Sciences, Oklahoma State University, Stillwater, OK This study assessed attitudes, knowledge, and consumption of fruit and vegetables by Oklahoma State University college students. Research questionnaires were distributed to 995 randomly selected students living in the residence halls. Data collected (N=233; 23%) were analyzed using frequencies, correlations, percentages, t-tests, ANOVA and Duncan's Multiple Range Test to determine if associations existed between specific characteristics of the respondents, their attitudes and knowledge, and their fruit and vegetable consumption patterns. Commonly consumed fruits and vegetables include orange juice, bananas, apples, fried and mashed potatoes, tossed salad, and carrots. Appearance/condition, freshness/ripeness, and taste/flavor were perceived as very important in fruit and vegetable consumption/selection by a majority of the respondents. Perception/attitudes about 5 A Day was associated with increased intake of many fruits and vegetables. The majority of the respondents have knowledge of the USDA Dietary Guidelines; however, less than 10 percent of the students consumed most of the fruits and vegetables listed in the survey. For the commonly eaten fruits and vegetables, only 19 percent of the students met the USDA Dietary Guidelines. Males consumed significantly more fruit juices and starchy vegetables than female students. Graduate and minority students ate a greater variety and amount of some fruits and vegetables. Additional research needs to be conducted nationwide to discover actual fruit and vegetable consumption of young adults. Knowledge of the USDA Dietary Guidelines do not always imply actual consumption, hence nutrition and health educators need to creatively promote the 5 A Day Program to increase consumption of fruits and vegetables.
USE OF THE FOOD GUIDE PYRAMID TO IMPROVE DIETARY
A-12 / SEPTEMBER 1994 SUPPLEMENT VOLUME 94 NUMBER 9
INTAKE AND REDUCE CARDIOVASCULAR RISK IN ACTIVE DUTY AIR FORCE MEMBERS. P.J. Gambera, RD, P.A. Davis, PhD, and B.O. Schneeman, PhD, Departments of Nutrition and Clinical Nutrition, University of California, Davis, CA The goal of this study was to determine if adherence to the Food Guide Pyramid guidelines, when combined with exercise, results in significant reductions in cardiovascular risk and enhancement in aerobic capacity (VO max) when compared to a regimen of exercise therapy alone. Twenty men and twelve women, mean age=32, with similar baseline VO, max, total cholesterol (TC), low density lipoprotein (LDL), body mass index (BMI), and dietary fat intakes were randomized into two groups. All subjects participated in a 90day fitness improvement program. One-half of the subjects (treatment group), received weekly, individualized dietary counseling using the Food Guide Pyramid asan educational tool. All participants completed a food frequency questionnaire at baseline and posttreatment. Those in the treatment group maintained three-day food records throughout the study to monitor compliance and assess changes in food intake. Nutritionist III software was used to analyze food records. Substantial changes in diet occurred for the treatment group from baseline. Mean percentage energy from fat decreased from 39% to 23% and mean servings from each of the food groups changed to reflect current guidelines: Milk (1.6 to 2.6), meat (4.5 to 3.0), vegetable (2.0 to 2.6), fruit (0.8-3.6) and bread (5.3 to 7.5) servings respectively. The treatment group also experienced significant reductions in TC, LDL, and BMI, of 9% (p=0.0032), 13% (p=.005) and 2% (p=0.0001) respectively. Significant improvements in fitness, as measured by VO: max (p=0.01) of 14% in the control and 43% in the treatment group were achieved. We conclude that dietary modification in accordance with the Food Guide Pyramid and the Dietary Guidelines for Americans results in significant reductions in known cardiovascular risk factors and improves the response to exercise training.
SELF-EFFICACY FOR FRUIT AND VEGETABLE CONSUMPTION AMONG 4TH AND 5TH GRADERS: RELIABILITY AND VALIDITY. S.B. Domel, PhD,RD,LD, W.O. Thompson, PhD, S.B. Leonard, MS,RD,LD, and J. Baranowski, MPH,RD,LD, Medical College of Georgia, Georgia Prevention Institute, Augusta, GA Most American adults and children eat fewer servings of fruits and vegetables (F&V) than the Year 2000 goal of 5 or more a day. Eating is a behavior; self-efficacy concerns the beliefs a person has about how able s/he is of performing a particular behavior In particular situations. Bandura proposed that behavior change will occur only when the person has a substantial level of self-efficacy, or confidence, for the new behavior. The purpose of this study was to develop, pilot-test, and field-apply a self-efficacy questionnaire regarding F&V consumption among 4th and 5th grade students. This study was part of a larger study concerning an Intervention to promote F&V consumption among students this age. The sample included 392 students with 140 from one school for pilot-testing and 252 from two schools for field application; subjects were primarily African American or white, non-Hispanic. The questionnaire included 34 items generated by inventorying behaviors targeted for change In the F&V school curriculum. Principal components analysis ndicated 4 subscales (after-school F&V snacks; breakfast and lunch F&V, and paying for F&V; independent shopping for F&V; and assisted shopping for F&V) accounting for 43.8% of the total variance. Means for the "assisted shopping for F&V" subscale were higher than the other three subscale means regardless of gender, grade, and ethnicity. Subscale test-retest reliabilities (Pearson productmoment correlations) within school ranged from .39 to .65; subscale internal consistencies (Cronbach's alpha coefficient) within schools ranged from .71 to .86. Pearson correlation coefficients between F&V self-efficacy subscales and F&V consumption (from food records) were low (-.02 to .17). Correlation coefficients for the F&V self-efficacy subscales were higher with F&V preferences (.03 to .49) and F&V outcome expectations (.02 to .25) than with F&V consumption. Further research concerning children's F&V selfefficacy must be placed within a broader context which considers the extent to which children control factors effecting F&V availability.
5 A DAY FOR BETTER HEALTH AMONG COLLEGE STUDENTS. L.L. Ebro, PhD, RD, LD, R. Plato-Wilbum, MS, RD, LD and B.H. Kopel, EdD, RD, LD, College ofHuman Environmental Sciences, Oklahoma State University, Stillwater, OK This study assessed attitudes, knowledge, and consumption of fruit and vegetables by Oklahoma State University college students. Research questionnaires were distributed to 995 randomly selected students living in the residence halls. Data collected (N=233; 23%) were analyzed using frequencies, correlations, percentages, t-tests, ANOVA and Duncan's Multiple Range Test to determine if associations existed between specific characteristics of the respondents, their attitudes and knowledge, and their fruit and vegetable consumption patterns. Commonly consumed fruits and vegetables include orange juice, bananas, apples, fried and mashed potatoes, tossed salad, and carrots. Appearance/condition, freshness/ripeness, and taste/flavor were perceived as very important in fruit and vegetable consumption/selection by a majority of the respondents. Perception/attitudes about 5 A Day was associated with increased intake of many fruits and vegetables. The majority of the respondents have knowledge of the USDA Dietary Guidelines; however, less than 10 percent of the students consumed most of the fruits and vegetables listed in the survey. For the commonly eaten fruits and vegetables, only 19 percent of the students met the USDA Dietary Guidelines. Males consumed significantly more fruit juices and starchy vegetables than female students. Graduate and minority students ate a greater variety and amount of some fruits and vegetables. Additional research needs to be conducted nationwide to discover actual fruit and vegetable consumption of young adults. Knowledge of the USDA Dietary Guidelines do not always imply actual consumption, hence nutrition and health educators need to creatively promote the 5 A Day Program to increase consumption of fruits and vegetables.
USE OF THE FOOD GUIDE PYRAMID TO IMPROVE DIETARY
A-12 / SEPTEMBER 1994 SUPPLEMENT VOLUME 94 NUMBER 9
INTAKE AND REDUCE CARDIOVASCULAR RISK IN ACTIVE DUTY AIR FORCE MEMBERS. P.J. Gambera, RD, P.A. Davis, PhD, and B.O. Schneeman, PhD, Departments of Nutrition and Clinical Nutrition, University of California, Davis, CA The goal of this study was to determine if adherence to the Food Guide Pyramid guidelines, when combined with exercise, results in significant reductions in cardiovascular risk and enhancement in aerobic capacity (VO max) when compared to a regimen of exercise therapy alone. Twenty men and twelve women, mean age=32, with similar baseline VO, max, total cholesterol (TC), low density lipoprotein (LDL), body mass index (BMI), and dietary fat intakes were randomized into two groups. All subjects participated in a 90day fitness improvement program. One-half of the subjects (treatment group), received weekly, individualized dietary counseling using the Food Guide Pyramid asan educational tool. All participants completed a food frequency questionnaire at baseline and posttreatment. Those in the treatment group maintained three-day food records throughout the study to monitor compliance and assess changes in food intake. Nutritionist III software was used to analyze food records. Substantial changes in diet occurred for the treatment group from baseline. Mean percentage energy from fat decreased from 39% to 23% and mean servings from each of the food groups changed to reflect current guidelines: Milk (1.6 to 2.6), meat (4.5 to 3.0), vegetable (2.0 to 2.6), fruit (0.8-3.6) and bread (5.3 to 7.5) servings respectively. The treatment group also experienced significant reductions in TC, LDL, and BMI, of 9% (p=0.0032), 13% (p=.005) and 2% (p=0.0001) respectively. Significant improvements in fitness, as measured by VO: max (p=0.01) of 14% in the control and 43% in the treatment group were achieved. We conclude that dietary modification in accordance with the Food Guide Pyramid and the Dietary Guidelines for Americans results in significant reductions in known cardiovascular risk factors and improves the response to exercise training.