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Research ArticleOriginal Research

Poor Nutritional Habits: A Modifiable Predecessor of Chronic Illness? A North Carolina Family Medicine Research Network (NC-FM-RN) Study

Nicole D. Gaskins, Philip D. Sloane, C. Madeline Mitchell, Alice Ammerman, Scott B. Ickes and Christianna S. Williams
The Journal of the American Board of Family Medicine March 2007, 20 (2) 124-134; DOI: https://doi.org/10.3122/jabfm.2007.02.060151
Nicole D. Gaskins
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Philip D. Sloane
MD, MPH
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C. Madeline Mitchell
MURP
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Alice Ammerman
DrPH, RD
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Scott B. Ickes
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Christianna S. Williams
PhD
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  • Figure 1.
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    Figure 1.

    Racial and ethnic differences in the percentage of respondents reporting selected nutritional habits. P values are based on logistic regression models with given food habit as the dependent variable and race/ethnicity as the independent variable, adjusted for clinic site, age, sex, smoking status, alcohol consumption, physical activity, self-rated health, and BMI. N ranges from 1323 to 1357, depending on missing data for the food habit. Percentages are not adjusted. ∗, P < .05; ∗∗, P < .01; and ∗∗∗, P < .001 for comparison with white, non-Hispanic respondents.

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    Figure 2.

    Comparison of selected nutritional habits of diabetics with those of nondiabetics who are at high risk for the disease. P values are based on logistic regression models with given food habit as the dependent variable and diabetes group as the independent variable, adjusted for clinic site, age, sex, race, smoking status, alcohol consumption, and physical activity. N ranges from 801 to 822, depending on missing data for the food habit. Percentages are unadjusted.

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    Table 1.

    Demographic and Health Status of Study Participants (N = 1714)*

    NumberPercentageMeanSDRange
    Age (years)47.416.918.0, 94.9
    Gender
        Male60435.3
        Female110764.7
    Education
        8th grade or less20011.8
        High school, no diploma20512.1
        High school graduate or GED50630.0
        Some college, no degree38722.9
        Associate’s degree1448.5
        Bachelor’s degree1518.9
        Postgraduate school or degree955.6
    Married/living with partner105262.8
    Race/ethnicity
        African American27516.8
        White, non-Hispanic98260.1
        American Indian1247.6
        Hispanic/Latino24214.8
        Other120.7
    Practice location
        A44125.7
        B39022.8
        C62136.2
        D26215.3
    Current health problems
        Heart disease21012.7
        High blood pressure70041.6
        Lung disease975.9
        Stroke or mini-stroke724.4
        Depression53832.4
        Chronic back pain47828.8
        Cancer764.6
        Diabetes29117.5
        Osteoarthritis23714.4
        Rheumatoid arthritis1509.1
        Fibromyalgia1056.4
    Self-reported health
        Excellent1428.3
        Very good39223.0
        Good57533.7
        Fair45826.8
        Poor1408.2
    Drinks alcohol53631.7
    Engaged in physical activity in past week98159.5
    Physically active 5 days/week, >30 minutes/day64239.0
    Current smoker40123.6
    Body mass index (BMI)29.67.115.0, 64.6
        Normal or underweight (BMI <25)414†27.3
        Overweight (BMI 25–30)48431.9
    Obese (BMI >30)62140.9
    • * The sample N includes all those who answered the nutritional habit questions. The sample size for individual characteristics varies from 1519 to 1711 because of missing data.

    • † Includes 30 people classified as underweight (BMI <18.5).

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    Table 2.

    Self-Reported Nutritional Habits of Study Participants (N = 1714)*

    Item and Response Choices from Nutritional Habits SurveyNumberPercentage
    Number of times fast food eaten per week23914.6
        0
        1 to 287753.4
        3 or more52632.0
    Number of glasses of soda or sweet tea consumed per day54932.7
        0
        1 to 263938.0
        3 or more49229.3
    Number of times high-fat snacks consumed per week83650.4
        0 to 1
        243826.4
        3 or more38623.3
    Number of times desserts or sweets consumed per week61036.4
        0 to 1
        243325.9
        3 or more63137.7
    Amount of margarine, butter, meat fat consumed72942.7
        None or very little
        Some78746.1
        A lot19211.2
    Number of servings of fruits or vegetables eaten per day56834.4
        3 or more
        256234.1
        1 or less51931.5
    Number of times lean protein eaten per week94756.5
        3 or more
        1 to 267440.2
        0553.3
    Overall Nutritional Habit Score (0–14), Mean (SD)†6.01(2.73)
    • * The sample N includes all those who answered at least 5 of the 7 nutritional habit questions. The sample size for individual items varies from 1642 to 1708 because of missing data.

    • † Scored as the sum of the 7 items, each 0 to 2, with higher scores reflecting poorer nutritional habits. If 2 or fewer items were missing, values for missing items were imputed as the mean of the nonmissing items. Cronbach’s α for the score is 0.558, and item total correlation range from 0.069 (lean protein consumption) to 0.407 (high-fat snack consumption). The median value is 6, and the most common (modal) value is 7.0, indicating very little skew. Visual inspection of the distribution and Q-Q plot indicate that the assumption of a normal distribution (and the application of parametric statistical tests) is valid.

    • View popup
    Table 3.

    Relationship between Nutritional Habit Score and Selected Demographic and Health Status Variables (N = 1714)

    VariableNutritional Habit ScoreP Value*
    MeanSD
    Race/ethnicity
        African American6.272.79.297
        American Indian6.572.56.759
        Hispanic/Latino5.102.45<.001
        Other5.622.13.285
        White, non-Hispanic6.122.79—
    Diabetes/pre-diabetes
        Not diabetic and low risk6.122.74<.001
        Not diabetic and high risk6.432.68<.001
        Diabetic5.062.64—†
    Sex
        Male6.362.65<.001
        Female5.822.75—
    Age
        18 to 44 years old6.422.76<.001
        45+ years old5.672.67
    Smoking status
        Nonsmoker5.732.68<.001
        Smoker6.912.70—
    Alcohol consumption
        Do not drink alcohol5.872.68.002
        Drink alcohol6.322.81—
    Physically active 5 days/week, >30 minutes/day
        No6.092.65.350
        Yes5.942.85—
    Self-reported health status
        Fair/poor5.912.57.493
        Good/very good/excellent6.072.81—
    BMI
        Normal or underweight5.992.90.632
        Overweight6.252.69.431
        Obese6.112.68—‡
    • * Based on ANOVA with nutritional habit score as the dependent variable and the specified demographic or health status characteristic as the independent variable and adjusting for practice location.

    • † P value for comparison of low risk versus high risk among nondiabetics is .097.

    • ‡ P value for comparison of normal/underweight versus overweight is 0.243.

    • View popup
    Table 4.

    Multiple Linear Regression for Nutritional Habit Score (N = 1424)

    VariableEstimateSEP Value
    Intercept7.6820.329<.001
    Race/ethnicity<.001*
        African American0.3630.198.067
        American Indian−0.1090.342.750
        Hispanic/Latino−1.2840.273<.001
        Other−0.7260.892.416
        White, non-Hispanicreference
    Diabetes/prediabetes<.001†
        Not diabetic, low risk0.5380.215.013
        Not diabetic, high risk1.1640.199<.001
        Diabeticreference
    Male gender0.5710.148.001
    Age (per year)−0.0410.005<.001
    Practice location.003‡
        A0.3000.205.143
        B−0.2570.215.232
        C0.6280.283.027
        Dreference
    Smoker0.8340.168<.001
    Drinks alcohol−0.2620.162.106
    Physically active 5 days/week, >30 minutes/day−0.2450.147.097
    Self-reported health status as very good or excellent−0.1020.159.521
    • * Overall type 3 P value for race/ethnicity (4 df); additional pairwise comparisons in which P < .05 include African American versus Hispanic/Latino (P < .001) and American Indian versus Hispanic/Latino (P = .005).

    • † Overall type 3 P value for diabetes status (2 df); P value for pairwise comparison of high and low risk nondiabetics is <0.001.

    • ‡ Overall type 3 P value for clinic location (3 df). Pairwise comparisons that are significant at P < .05 include A versus B (P = .004) and B versus C (P < .002).

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The Journal of the American Board of Family Medicine: 20 (2)
The Journal of the American Board of Family Medicine
Vol. 20, Issue 2
March-April 2007
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Poor Nutritional Habits: A Modifiable Predecessor of Chronic Illness? A North Carolina Family Medicine Research Network (NC-FM-RN) Study
Nicole D. Gaskins, Philip D. Sloane, C. Madeline Mitchell, Alice Ammerman, Scott B. Ickes, Christianna S. Williams
The Journal of the American Board of Family Medicine Mar 2007, 20 (2) 124-134; DOI: 10.3122/jabfm.2007.02.060151

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Poor Nutritional Habits: A Modifiable Predecessor of Chronic Illness? A North Carolina Family Medicine Research Network (NC-FM-RN) Study
Nicole D. Gaskins, Philip D. Sloane, C. Madeline Mitchell, Alice Ammerman, Scott B. Ickes, Christianna S. Williams
The Journal of the American Board of Family Medicine Mar 2007, 20 (2) 124-134; DOI: 10.3122/jabfm.2007.02.060151
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