Lenore Arab

San Diego State University, San Diego, California, United States

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Publications (10)36.65 Total impact

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    ABSTRACT: We pooled data from 5 large validation studies of dietary self-report instruments that used recovery biomarkers as references to clarify the measurement properties of food frequency questionnaires (FFQs) and 24-hour recalls. The studies were conducted in widely differing US adult populations from 1999 to 2009. We report on total energy, protein, and protein density intakes. Results were similar across sexes, but there was heterogeneity across studies. Using a FFQ, the average correlation coefficients for reported versus true intakes for energy, protein, and protein density were 0.21, 0.29, and 0.41, respectively. Using a single 24-hour recall, the coefficients were 0.26, 0.40, and 0.36, respectively, for the same nutrients and rose to 0.31, 0.49, and 0.46 when three 24-hour recalls were averaged. The average rate of under-reporting of energy intake was 28% with a FFQ and 15% with a single 24-hour recall, but the percentages were lower for protein. Personal characteristics related to under-reporting were body mass index, educational level, and age. Calibration equations for true intake that included personal characteristics provided improved prediction. This project establishes that FFQs have stronger correlations with truth for protein density than for absolute protein intake, that the use of multiple 24-hour recalls substantially increases the correlations when compared with a single 24-hour recall, and that body mass index strongly predicts under-reporting of energy and protein intakes.
    American Journal of Epidemiology 06/2014; · 4.98 Impact Factor
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    ABSTRACT: Background Evidence is mixed regarding sugar-sweetened beverage (SSB) intake and adiposity among adults, perhaps due to reporting bias.Objective To determine the impact of reporting bias on any associations between increased SSB intake and overweight/obesity.DesignBeverage intake and overweight/obese status (BMI 25 kg/m2) was examined among adults from a dietary assessment and doubly labeled water study (n=250). Four web-based, 24-hour recalls assessed dietary intake. SSB intake was categorized as no intake, 1-99 kcals per day, and >99 kcals per day. Logistic regression models adjusted for total caloric intake, age, race, education and diet quality compared SSB intake to overweight/obese status. To investigate dietary self-reporting bias, analyses were replicated in a subset of 'true reporters': those with self-reported total caloric intake within 25% of total energy expenditure per doubly labeled water assessments (n=108).ResultsOne-half of participants were overweight/obese; more overweight/obese participants consumed SSB than normal weight participants (69 vs 47% P<0.001). Intake of other beverages did not differ by adiposity. Less White participants (48%) consumed SSB compared to African-American participants (68% P=0.002). Compared to no intake, SSB intake up to the median intake doubled the risk of being overweight/obese (OR: 2.1, 95% CI: 1.0-4.3; P=0.046), and SSB intake over the median more than doubled the risk (OR: 2.6, 95% CI: 1.2-6.0; P=0.018). When limited to true reporters, SSB intake significantly increased the risk of being overweight/obese by nearly 4 fold.Conclusion Underreporting of SSB intake may be attenuating true associations of SSB intake and the risk of being overweight/obese.International Journal of Obesity accepted article preview online, 19 July 2013. doi:10.1038/ijo.2013.130.
    International journal of obesity (2005) 07/2013; · 5.22 Impact Factor
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    ABSTRACT: The timing of energy intake is a modifiable behaviour that may influence energy regulation and the risk of obesity. We examined the associations of energy intake in the morning, midday and evening with body mass index (BMI) (n = 239). Cross-sectional analyses were performed using data from the University of California, Los Angeles Energetics Study. Energy intake was assessed using three 24-h dietary recalls and stratified by time-of-day: morning (00.00 h to 11.00 h), midday (11.00 h to 17.00 h) and evening (17.00 h to 00.00 h). Sensitivity analysis was conducted among 'true-reporters', whose self-reported energy intake was ±25% of total energy expenditure measured by doubly-labelled water (n = 99). Logistic regression models were performed adjusting for age, sex, race, education, total daily energy intake and physical activity. Energy intake in the morning was not associated with BMI. Participants who consumed ≥33% (versus <33%) of their daily energy intake at 12.00 h were (nonsignificantly) less likely to be overweight/obese [odds ratio (OR) = 0.68; 95% confidence interval (CI) = 0.37-1.24] and this association was stronger and statistically significant among true-reporters (OR = 0.34; 95% CI = 0.12-0.95). Those who consumed ≥33% of daily energy intake in the evening were two-fold more likely overweight/obese (OR = 2.00; 95% CI = 1.03-3.89), although this association was not significant among true-reporters (OR = 2.10; 95% CI = 0.60-7.29). These data indicate that eating more of the day's total energy intake at midday is associated with a lower risk of being overweight/obese, whereas consuming more in the evening is associated with a higher risk. Randomised trials are needed to test whether shifting energy intake earlier in the day could have a regulatory effect with respect to reducing intake in the evening, thereby promoting weight loss and maintenance.
    Journal of Human Nutrition and Dietetics 06/2013; · 2.07 Impact Factor
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    ABSTRACT: Other than the in vitro erythrocyte hemolysis test, no valid biomarkers of vitamin E status currently exist. We hypothesized that the urinary vitamin E metabolite α-carboxyethyl hydroxychroman (α-CEHC) could serve as a biomarker. The relations between urinary α-CEHC, plasma α-tocopherol, and vitamin E intakes were assessed by using a previously validated multipass, Web-based, 24-h self-administered dietary recall, and we concurrently collected plasma and 24-h urine samples from 233 participants of both sexes. Median vitamin E intakes were 9.7 mg α-tocopherol/d. Intakes were correlated with plasma α-tocopherol (R = 0.40, P < 0.001) and urinary α-CEHC (R = 0.42, P < 0.001); these correlations were essentially unchanged after multivariate adjustments. On the basis of multiple regression analysis, urinary α-CEHC excretion increased by ∼0.086 μmol/g creatinine (95% CI: 0.047, 0.125) for every 1-mg (2.3-μmol) increase in dietary α-tocopherol. Urinary α-CEHC excretion remained at a plateau (median: 1.39 μmol/g creatinine) until dietary intakes of α-tocopherol exceeded 9 mg α-tocopherol/d. The inflection point at which vitamin E metabolism increased was estimated to be at an intake of 12.8 mg α-tocopherol/d. Daily excretion of >1.39 μmol α-CEHC/g creatinine is associated with a greater than adequate α-tocopherol status, as evidenced by increased vitamin E metabolism and excretion. Thus, urinary α-CEHC is a valid biomarker of α-tocopherol status that can be used to set a value for the Estimated Adequate Requirement of vitamin E.
    American Journal of Clinical Nutrition 09/2012; 96(4):801-9. · 6.50 Impact Factor
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    ABSTRACT: BACKGROUND: Successfully changing patients' dietary behavior is a challenging problem in the management of chronic kidney disease (CKD). We conducted a pilot study to test the feasibility and acceptability of an Internet-based, self-administered, dietary assessment tool equipped with instructional feedback, aimed at facilitating dietary adherence to disease-specific nutritional guidelines among CKD stage IV patients while reducing resource burdens on providers. METHODS: Focus groups were used to develop a user-friendly dietary reporting format. The report was then calibrated to the dietary guidelines outlined by Kidney Disease Outcomes Quality Initiative (K/DOQI) and incorporated into the assessment tool. Elements of the report were developed based on the "transtheoretical model of behavior change" theory, aimed at facilitating patients to enter the action stage of change. The tool was later deployed in a nephrology care site at an academic medical center, where 12 patients diagnosed with stage IV CKD (late-stage, predialysis) completed a dietary assessment before their provider encounter as well as questionnaires gauging their computer literacy, nutritional education history, nutritional knowledge and awareness, and acceptability of the tool. The report was made available to the provider during the clinical encounter, and both patient and physician perception of the report's utility was assessed after the encounter. RESULTS: Approximately 25% to 30% of the patients were severely noncompliant to the K/DOQI guidelines for each nutrient. Awareness about the role of diet in CKD management was widely variable, ranging from 0% to 58% of the patients over different nutrients. All of the patients successfully completed the Web-based dietary assessment. Eighty-four percent of the patients positively rated the tool on its ability to record the patients' dietary data, 58% noted the tool was always able to satisfactorily estimate portion sizes, and 50% thought the navigation was easy or very easy. Eleven of the 12 patients were satisfied with the time taken (range: 10 to 40 minutes, median time: 20 minutes) to complete the dietary assessment. Patients and physicians differed considerably in their perception of the use of the report during the clinical encounter. CONCLUSION: Dietary knowledge and adherence to K/DOQI guidelines among CKD patients is suboptimal. However, interest and motivation is high. Web-based tools are well accepted among CKD patients as an aid to assessing dietary adherence to K/DOQI guidelines and may pose a cost-effective approach to bridging the adherence gap.
    Journal of Renal Nutrition 07/2012; · 1.75 Impact Factor
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    ABSTRACT: High levels of circulating advanced glycation end products (AGE) are associated with cardiovascular disease, diabetes, chronic kidney disease, and increased mortality, but factors that influence levels of circulating AGE are not well known. Our objective was to characterize the relationship between serum carboxymethyl-lysine (CML), a major circulating AGE, and body composition in adults. In a cross-sectional study, total body DXA was performed and serum CML was measured in 592 adults, aged 26-93 y, from the Baltimore Longitudinal Study of Aging. Median (25th, 75th percentile) CML concentrations were 2.26 (1.86, 2.67) μmol/L. Total fat mass [β = -0.17 (95% CI -0.10, -0.24); P < 0.0001], truncal fat mass [β = -0.17 (95% CI -0.10, -0.25); P < 0.0001], and appendicular fat mass [β = -0.13 (95% CI -0.05, -0.20); P = 0.001] per 1 SD increase were inversely associated with serum CML in separate multivariate linear regression models, adjusting for age, sex, BMI, systolic blood pressure, TG, HDL cholesterol, and renal function. Lean body mass was not independently associated with serum CML. These findings suggest that serum CML concentration is strongly affected by body fat, possibly because CML is preferentially deposited in fat tissue or because adipocytes affect the metabolism of AGE.
    Journal of Nutrition 09/2011; 141(9):1726-30. · 4.23 Impact Factor
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    ABSTRACT: Advanced glycation end products (AGEs) are implicated in the pathogenesis of atherosclerosis, diabetes and kidney disease. The objective was to describe dietary intake, the dominant source of exposure to AGEs, with carboxymethyl-lysine (CML), a major AGE, in serum and urine, respectively. Serum and urinary CML were measured in 261 adults, aged 21-69 years, and compared with diet as assessed by six separate 24-h dietary recalls. Median (25th, 75th percentile) serum and urinary CML concentrations were 686 (598, 803) μg/l and 1023 (812, 1238) μg/gm creatinine. There was no correlation between serum and urinary CML (r=-0.02, P=0.78). Serum CML was positively correlated with intake of soy, fruit juice, cold breakfast cereal, non-fat milk, whole grains, fruit, non-starchy vegetables and legumes, and negatively correlated with intake of red meat. Intake of fast food was not significantly correlated with serum CML. Urinary CML was positively correlated with intake of starchy vegetables, whole grains, sweets, nuts/seeds and chicken, and negatively correlated with intake of fast foods. Intake of AGE-rich foods such as fried chicken, French fries, bacon/sausage and crispy snacks were not significantly correlated with serum or urinary CML, except for a significant negative correlation between fried chicken and serum CML. These findings suggest that the high consumption of foods considered high in CML is not a major determinant of either serum or urinary CML. Further work is needed to understand the relationship of AGEs in blood and urine with the metabolism of dietary AGEs.
    European journal of clinical nutrition 07/2011; 66(1):3-9. · 3.07 Impact Factor
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    ABSTRACT: The accuracy of dietary recalls might be enhanced by providing participants with photo images of foods they consumed during the test period. We examined the feasibility of a system (Image-Diet Day) that is a user-initiated camera-equipped mobile phone that is programmed to automatically capture and transmit images to a secure website in conjunction with computer-assisted, multipass, 24-h dietary recalls in 14 participants during 2007. Participants used the device during eating periods on each of the three independent days. Image processing filters successfully eliminated underexposed, overexposed and blurry images. The captured images were accessed by the participants using the ImageViewer software while completing the 24-h dietary recall on the following day. None of the participants reported difficulty using the ImageViewer. Images were deemed 'helpful' or 'sort of helpful' by 93% of participants. A majority (79%) of users reported having no technical problems, but 71% rated the burden of wearing the device as somewhat to very difficult, owing to issues such as limited battery life, self-consciousness about wearing the device in public and concerns about the field of view of the camera. Overall, these findings suggest that automated imaging is a promising technology to facilitate dietary recall. The challenge of managing the thousands of images generated can be met. Smaller devices with a broader field of view may aid in overcoming self-consciousness of the user with using or wearing the device.
    European journal of clinical nutrition 05/2011; 65(10):1156-62. · 3.07 Impact Factor
  • Nataliya Volkova, Lenore Arab
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    ABSTRACT: An evidence-based evaluation of peer-reviewed original research published during 1980 to 2004 and examining the relationship between hemoglobin and/or hematocrit values and all-cause mortality in dialysis patients was conducted to compare the studies' designs, analytic strategies, and results. The search targeted MEDLINE and EMBASE and included publications referenced in the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative Anemia Guidelines. Both randomized clinical trials (RCTs) and observational studies were considered. Of 7 RCTs and 20 observational studies identified, 5 trials and 13 studies were included in evidence tables. The trials were underpowered to study mortality and enrolled different patient populations, limiting their generalizability. Although none reached statistical significance, trials focusing on a general dialysis population tended to show either no effect or a benefit of greater hemoglobin level target, whereas trials enrolling cardiac patients suggested increased mortality associated with greater hemoglobin levels. The observational studies were heterogeneous in design, used varying exposure categorizations, and controlled for different covariates, but generally were supportive of increased mortality associated with a hemoglobin level less than the reference range. Evidence of benefits or risks of hemoglobin levels greater than the reference was variable. RCT-based evidence relating hemoglobin and/or hematocrit values to mortality in dialysis patients is limited. The relationship may be modified by the presence of preexisting conditions (cardiac disease). The published literature is insufficient for generalization of risks or benefits of a hemoglobin level greater than 11 to 12 g/dL (>110 to 120 g/L). There is a need for better designed RCTs focusing on mortality as a primary outcome and enrolling patients without cardiac disease. Observational studies should adequately control for relevant confounders (eg, baseline comorbidities) and assess effect modification in the analysis.
    American Journal of Kidney Diseases 02/2006; 47(1):24-36. · 5.76 Impact Factor
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    ABSTRACT: This paper presents an assisted recall system, Rewind, that employs automatic image capture on mobile phones and filtering of images for end-user viewing. The usability of image-based assisted recall systems is limited by the large number of images through which the user must navigate. Rewind is a scalable system of everyday mobile phones and supporting web services that we developed to explore how client-and server-side image processing can be used to both lower bandwidth needs and streamline user navigation. It has been in use since August 2007 as part of a pilot study super-vised by an epidemiologist to evaluate its utility for improving re-call of dietary intake, as well as other shorter and more exploratory trials. While the system is designed to accommodate a range of image processing algorithms, in this first prototype we rely on sim-ple filtering techniques to evaluate our system concept. We present performance results for a configuration in which the processing oc-curs on the server, and then compare this to processing on the mo-bile phones. Simple image processing on the phone can address the narrow-band and intermittent upload channels that characterize cellular infrastructure, while more sophisticated processing tech-niques can be implemented on the server to further reduce the num-ber of images displayed to users.

Publication Stats

113 Citations
36.65 Total Impact Points


  • 2013
    • San Diego State University
      San Diego, California, United States
  • 2011–2013
    • University of California, Los Angeles
      • Department of Medicine
      Los Angeles, California, United States
  • 2012
    • Oregon State University
      Corvallis, Oregon, United States
  • 2006
    • Emory University
      • Department of Epidemiology
      Atlanta, GA, United States