High Vegetable and Fruit Diet Intervention in Premenopausal Women with Cervical Intraepithelial Neoplasia

doi:10.1016/S0002-8223(01)00286-3

Journal of the American Dietetic Association

Volume 101, Issue 10, October 2001, Pages 1167-1174

https://doi.org/10.1016/S0002-8223(01)00286-3 Get rights and content

Abstract

Objective To examine whether diet intervention can promote increased vegetable and fruit intake, as reflected in increased plasma carotenoid and decreased plasma total homocysteine concentrations, in premenopausal women with cervical intraepithelial neoplasia, a precancerous condition.

Design Randomized controlled diet intervention study. Subjects Fifty-three free-living premenopausal women who had been diagnosed with cervical intraepithelial neoplasia, were randomly assigned to an intervention (n=27) or a control (n=26) group.

Intervention Individualized dietary counseling to increase vegetable and fruit intake.

Main outcome measures Diet was assessed by food frequency questionnaire. Plasma carotenoids and total homocysteine were measured at enrollment and at 6 months follow up.

Analysis Associations between baseline plasma concentrations of carotenoids and homocysteine and influencing factors were examined with multiple regression analysis. Repeated measures analysis of variance was used to test for group by time effects in these plasma concentrations. Plasma carotenoids at baseline and 6 months in the study groups, and differences in homocysteine concentrations from baseline to 6 months, were compared with independent sample t tests.

Results Repeated measures analysis of variance showed significant group by time effects (P<.01) in plasma carotenoid and homocysteine concentrations. In the intervention group, total plasma carotenoids increased by an average of 91%, from 2.04±0.13 (mean±standard error of the mean) to 3.90±0.56 μmol/L and plasma total homocysteine was reduced by 11%, from 9.01±0.40 to 8.10±0.44 μmol/L (P<.003). Neither changed significantly in the control group.

Applications Individualized dietary counseling can effectively promote increased vegetable and fruit intake in premenopausal women. This dietary pattern may reduce risk for cancer and other chronic diseases and also promote an improvement in folate status. J Am Diet Assoc. 2001:101;1167–1174.

Section snippets

Subjects

This study was part of a larger project examining whether a diet high in vegetables and fruit, which are rich in carotenoids, can promote a significantly increased rate of regression of CIN I or II in premenopausal women. Procedures for this study were approved by the Human Subjects Committee of the University of California-San Diego School of Medicine.

For the trial, women identified as having abnormal Pap smears were recruited from primary care and gynecology medical practices. Inclusion

Results

Subjects were 53 women aged 27.8±16.0 years (mean±standard deviation, range 19–45 years); 19 (36%) were 19 to 24 years, 27 (51%) were 25 to 34 years, and 7 (13%) were 35 years or older. Self-reported ethnicity was distributed as: 35 (66%) were white, 6 (11%) were Asian-American, 6 (11%) were African-American, 4 (8%) were Hispanic, and 2 (4%) were from other ethnic groups, distributed proportionately across the study groups. Sixty percent had been diagnosed with CIN I and 40% percent with CIN

Discussion

Results from this study demonstrate that diet intervention can effectively promote increased vegetable and fruit intake in premenopausal women with cervical dysplasia, reflected in a substantial increase in plasma carotenoid and a reduction in plasma total homocysteine concentrations. The intervention improved status for both carotenoids and folate in the target population and is a first step toward testing whether diet intervention can increase the regression rate of CIN.

At enrollment,

Applications

An individualized diet counseling intervention that emphasizes self management and self regulation is readily applicable for dietetics professionals. With this approach, counseling interactions involve setting subgoals and reviewing progress, and guidance is adjusted to accommodate the preferences and daily activity patterns of the client. Guiding clients as they select and reach specific behavioral targets requires regular and ongoing feedback, which can be facilitated by telephone and

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Plasma carotenoid levels as biomarkers of dietary carotenoid consumption: A systematic review of the validation studies
2015, Journal of Nutrition and Intermediary Metabolism
Previous research has demonstrated that plasma carotenoids are a reliable biomarker of usual fruit and vegetable intake. The review aims were to synthesize (i) the mean dietary intake and (ii) plasma concentrations of carotenoids reported from validation studies (iii) compare the strength of the relationship between the two, measured using different dietary assessment methods.
Six databases were used to locate studies that included: adult populations, assessment of dietary intake, measurement of plasma carotenoids and reported the comparison between the two measures.
One hundred and forty-two studies were included with 95,480 participants, the majority of studies were cross-sectional (n = 86), with randomized controlled trials (RCTs) (n = 18), 14 case–control studies and 13 cohorts. The most common reported dietary carotenoid and plasma carotenoid was lycopene: weighted dietary mean intake (4555.4 ug/day), and plasma concentration 0.62 umol/L (95% CI: 0.61, 0.63, n = 56studies. The strongest weighted correlation between the two measures was found for cryptoxanthin (r = 0.38, 95% CI 0.34, 0.42) followed by a-carotene (r = 0.34, 95% CI 0.31, 0.37).
This review summarizes typical dietary intakes and plasma concentrations and their expected associations based on validation studies conducted to date which provides a benchmark for future validation studies.
Tailored telephone education to promote awareness and adoption of fruit and vegetable recommendations among urban and mostly immigrant black men: A randomized controlled trial
2009, Preventive Medicine
Citation Excerpt :
Telephone-based education has become an increasingly popular means for delivering health education (Soet and Basch, 1997; Vanwormer et al., 2006). Some studies have used it to promote FV consumption in adults (Sorensen et al., 2007; Stevens et al., 2003; Pierce et al., 2004; Kristal et al., 2000; Marcus et al., 2001; Delichatsios et al., 2001; Rock et al., 2001; Emmons et al., 2005; Pakiz et al., 2005; Resnicow et al., 2005), but none have targeted urban and primarily immigrant black men. Telephone-based education does not require travel, can be done at convenient times, and can be implemented among individuals with low literacy.
Fruit and vegetable (FV) intake in black men are far below national recommendations.
Urban, primarily immigrant, black men (n = 490) from the New York City metropolitan area participating in the Cancer Awareness and Prevention (CAP) Trial (2005–2007) were randomly assigned to one of two intervention groups: 1) FV Education (FVE) or 2) Prostate Education (PE). Both interventions entailed a mailed brochure plus two tailored telephone education (TTE) calls. Outcomes, measured at baseline and at eight months, included knowledge of FV recommendations, perceived benefits, stage of readiness to adopt recommendations and self-reported FV consumption.
At follow-up, the FVE group consumed an average of 1.2 more FV servings per day than the PE group (P < 0.001; adjusted for baseline). The FVE group also demonstrated increases in knowledge about recommended FV amounts (P < 0.01) and appropriate serving sizes (P < 0.05), and in the percent of participants moving from a lower to a higher stage of readiness to adopt FV recommendations (P < 0.05). The FVE group did not demonstrate increases in knowledge related to the importance of eating a colorful variety or in the ability to name potential health benefits.
TTE can be a practical and moderately effective intervention for raising awareness of FV recommendations and for promoting FV consumption in urban and primarily immigrant black men.
Human Papillomavirus Infection in Men and Women: The Impact of Nutrition on Cervical Cancer
2004, Principles of Gender-Specific Medicine
Telephone-Based Counseling Improves Dietary Fat, Fruit, and Vegetable Consumption: A Best-Evidence Synthesis
2006, Journal of the American Dietetic Association
Citation Excerpt :
Sample sizes ranged from 56 to 2,970 randomized participants and attrition ranged between 1% and 40%. In addition to telephone-based counseling, intervention components included written nutrition information (14-17,20-22), personalized feedback letters (18,20,21), meal replacements (15), computerized assessments (14,19,21), group meetings/classes (17), clinical follow-ups (14,19,20), and e-counseling (17). Where specifically reported, participants received an average of 3.4 telephone counseling sessions (range 1 to 7) across 23.4 weeks (range 7 to 52).
Eating more fruits/vegetables and less dietary fat rank among the most important nutrition recommendations for health improvement. Telephone counseling is an increasingly popular means of delivering support for diet modification. Using a best-evidence synthesis, the purpose of this review was to assess the effectiveness of telephone-based counseling on improving dietary fat, fruit, and vegetable consumption for adults. Online databases and article bibliographies were searched to produce relevant randomized-controlled trials published during the past 5 years. Nine studies were ultimately included and the weight of the evidence indicated that telephone-based counseling promotes significantly greater improvements in fruit/vegetable consumption (median effect size=0.41) and dietary fat intake (median effect size=0.22) relative to usual care. Improvements were especially pronounced among women with (or at high risk for developing) cancer. In some studies, telephone-based counseling was also associated with greater improvement in blood lipid levels and weight. Based on these findings, several design considerations (eg, population focus, counseling intensity) for program managers are proposed. Telephone-based counseling was found to be a moderately effective intervention, but there are not enough studies yet to draw conclusions on other research questions, such as how advantageous telephone-based counseling is over traditional forms of dietary counseling. At present, telephone-based counseling may best be used as a complement to clinical care and a means to broaden the outreach of nutrition services.
α-Tocopherol and α-tocopheryl quinone levels in cervical intraepithelial neoplasia ana cervical cancer
2004, American Journal of Obstetrics and Gynecology
α-Tocopherol is a potent antioxidant that protects cell membranes against oxidative damage. Red blood cell α-tocopherol levels reflect membrane α-tocopherol concentrations, and altered levels may suggest membrane damage. The objective of this study was to determine the levels of α-tocopherol and α-tocopheryl quinone, the oxidized product of α-tocopherol, in plasma and red blood cells that were obtained from control subjects and patients with cervical intraepithelial neoplasia and cervical cancer.
In this cross-sectional study, 72 women, (32 African American and 40 Hispanic) were recruited. Among these subjects, 37 women had cervical intraepithelial neoplasia; 14 women had cervical cancer, and 21 women were considered control subjects, who had normal Papanicolaou test results. α-Tocopherol and α-tocopheryl quinone levels were determined in red blood cell and plasma by high-pressure liquid chromatography.
Plasma levels of α-tocopherol and α-tocopheryl quinone were decreased significantly (P = .012 and = .005, respectively, by Kruskal-Wallis test) in study groups compared with the control group; red blood cell levels of α-tocopherol and α-tocopheryl quinone were not altered significantly.
The lower α-tocopherol level that was observed in this study is consistent with our previous reports of decreased antioxidant concentrations and increased oxidative stress in women with cervical intraepithelial neoplasia. Unaltered red blood cell α-tocopherol and α-tocopheryl quinone levels suggest undamaged cell membrane. Further studies are needed to investigate the potential role of oxidative stress in cervical intraepithelial neoplasia.
Healthy eating index scores are associated with blood nutrient concentrations in the third national health and nutrition examination survey
2004, Journal of the American Dietetic Association
Citation Excerpt :
The fruit and vegetable components of the HEI were in fact correlated with total HEI in this dataset (r=0.59 and 0.38, respectively), while similar correlations were found in another study (r=0.57 and 0.29, respectively) (12). Carotenoids, folate, and vitamin C are largely found in fruits and vegetables, and blood concentrations of these nutrients may be reliable markers for fruit and vegetable intake (34–38). Not surprisingly, we found that these fruit and vegetable biomarkers in NHANES III were positively correlated with overall HEI scores, indicating that the HEI can be a good indicator of status of these nutrients.
The Healthy Eating Index (HEI) is a summary measure of dietary quality, based on a 100-point scale. Our objectives were to assess the HEI as a measure of dietary status through its correlation with nutritional biomarkers and to identify those biomarkers most associated with diet quality and healthful food intake patterns.
National Health and Nutrition Examination Survey (NHANES) III, 1988–94.
Adults (≥17 years) with calculated HEI scores and blood nutrient data (n=16,467).
Weighted crude and partial Pearson correlation coefficients (r) between HEI scores and blood nutrients were calculated. Geometric mean blood nutrient concentrations were calculated for five HEI score categories (ranging from ≤50 to >80).
HEI score was positively correlated with serum (r=0.25) and red blood cell (r=0.27) folate, serum vitamins C (r=0.30) and E (r=0.21), and all serum carotenoids except lycopene (r=0.17 to 0.27). These blood nutrient concentrations were 21% to 175% higher for participants in the highest HEI score group (>80) compared with those in the lowest group (≤50). Mean HEI scores were significantly (P<.0001) greater among the 42% of participants who took dietary supplements. Most correlations were attenuated when adjusted for additional factors.
HEI score is correlated with a wide range of blood nutrients; the strongest relationships are with biomarkers of fruit and vegetable intake. These results are an important step in the validation of the HEI, emphasizing its potential as a tool for nutrition and health studies.

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High Vegetable and Fruit Diet Intervention in Premenopausal Women with Cervical Intraepithelial Neoplasia

Abstract

Section snippets

Subjects

Results

Discussion

Applications

Am J Clin Nutr.

Gynecol Oncol.

Am J Obstet Gynecol.

Prev Med.

Am J CIin Nutr.

J Am Diet Assoc.

Pharmacol Ther.

J Nutr.

J Nutr.

J Am Diet Assoc.

Ann Epidemiol.

J Nutr.

J Am Diet Assoc.

Am J Clin Nutr.

Am J Clin Nutr.

J Nutr.

Lancet.

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J Nutr.

J Nutr.

Am J Clin Nutr.

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Antioxidant nutrientsassociations with persistent human papillomavirus infection

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Nutrition and cervical neoplasia

Cancer Causes Control.