Staff Food-Related Behaviors and Children’s Tastes of Food Groups during Lunch at Child Care in Oklahoma J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2017-10-05 Katherine Anundson, Susan B. Sisson, Michael Anderson, Diane Horm, Jill Soto, Leah Hoffman
BackgroundYoung children should consume a variety of nutrient-dense foods to support growth, while limiting added fat and sugar. A majority of children between the ages of 3 and 5 years attend child care in the United States, which makes this environment and the child-care staff influential at meals.ObjectiveThe aim was to determine the association between best-practice food-related behaviors and young children’s tastes of fruit, vegetable, low-fat dairy, and high-fat/high-sugar foods at child care.DesignThis was a cross-sectional study.ParticipantsA community-based study with 201 children ages 3 to 5 years from 25 early care and education centers, including 11 tribally affiliated centers and two Head Start programs across Oklahoma. Data collection occurred from fall 2011 to spring 2014.Main outcome measuresClassroom observations used the Environmental Policy Assessment Observation tool to measure the staff behaviors and environment. Staff behavior was compared at three different levels: the composite score of staff nutrition behavior, each constituent staff behavior, and staff behaviors grouped into broader feeding behaviors. Tasted food was measured through the Dietary Observation in Child Care method. The children’s meals were categorized into the following food groups: fruit, vegetable, low-fat dairy, fried vegetable, fried meat, high-fat meat, and high-fat/high-sugar food.Statistical analysis performedDescriptive statistics were calculated for relevant variables. Relationships between the constituent staff behaviors and food groups that children tasted were compared using multilevel mixed-model analysis.ResultsThe mean number of tasted fruit or vegetable items was higher and the mean number of tasted high-fat/high-sugar food items was lower when staff: 1) determined fullness before plate removal when less than half of food was eaten, 2) ate with the children, 3) and talked about healthy food.ConclusionsThe utilization of the three staff behaviors and their association with higher mean tastes of nutrient-dense items and lower mean tastes of high-fat/high-sugar food items among exposed children demonstrated support for the use of the best practices in early care and education centers.
Trends in Fast-Food and Sugar-Sweetened Beverage Consumption and Their Association with Social Environmental Status in South Korea J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2017-10-05 Hyunjung Lim, Hae Jeoung Lee, Ryowon Choue, Youfa Wang
BackgroundAs South Korea has enjoyed rapid economic development, Koreans’ diet, particularly consumption of fast food (FF) and sugar-sweetened beverages (SSBs), has changed.ObjectiveTo examine time trends in FF and SSB consumption and their associations with social environmental status (SEnS) in South Korea.DesignKorean National Health and Nutrition Examination Surveys (KNHANES) were a series of population-based cross-sectional surveys.ParticipantsData from the KNHANES conducted in 1998, 2001, 2005, and 2007-2009 for 49,826 Koreans aged ≥1 year were used.Main outcome measuresConsumption of FF and SSBs were assessed by a 24-hour recall. We defined two FF categories (Western-style and Korean-style) and one SSB category. Sex, age, household income, and residence regions were investigated.Statistical analyses performedThe primary sampling units, strata, and sampling weights were taken into account using SAS survey-related procedures. Logistic regression models were used to test associations between SEnS and FF consumption.ResultsOver an 11-year period, the proportion of participants’ who consumed Western FF and SSBs on the surveyed day doubled (P<0.05). Per capita energy contribution from Western FF also increased in adults, men, and low-income groups. SSB consumption doubled (per capita: 32 to 82 kcal/day, only consumers: 123 to 166 kcal/day), but consumption of Korean-style FF decreased (P<0.05). Compared with the low-income rural resident group, the high-income urban resident group was much more likely to consume Western FF (OR=26.7[3.7, 193.4]) and SSBs (odds ratio [OR]=3.1 [2.4, 4.1]) in 1998. However, in recent years, the patterns changed; the high-income urban resident group was more likely to consume Korean-style FF (OR=2.0[1.3, 2.9]) and SSBs (OR=1.7[1.3, 2.1]).ConclusionsIn South Korea, people who reported consuming Western FF and SSBs on the surveyed day almost doubled during 1998-2009, whereas those who consumed Korean FF decreased. SEnS was related to FF and SSB consumption.
Women’s Perceptions of Usefulness and Ease of Use of Four Healthy Eating Blog Characteristics: A Qualitative Study of 33 French-Canadian Women J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2017-10-26 Véronique Bissonnette-Maheux, Audrée-Anne Dumas, Véronique Provencher, Annie Lapointe, Marilyn Dugrenier, Sharon Straus, Marie-Pierre Gagnon, Sophie Desroches
BackgroundHealthy eating blogs are knowledge translation tools used by nutrition and dietetics practitioners for helping people improve their health behaviors and food choices.ObjectiveOur aim was to explore women’s perceptions of the usefulness and ease of use of healthy eating blog (HEB) characteristics that might increase potential users’ intention to use them as tools to improve their dietary habits.DesignWe conducted qualitative research using semi-structured individual interviews.ParticipantsThirty-three women (mean age of 44 years; range=27 to 61 years) living in the Quebec City, Canada, metropolitan area were studied.InterventionFour existing HEBs, written by French-Canadian registered dietitians (RDs) whose main objective was the promotion of a healthy diet, were explored by women during individual interviews. A standardized open-ended interview questionnaire based on the Technology Acceptance Model was used to identify women's perceptions about characteristics of type of blog content delivery, RD blogger's delivery of information, blog layout, and blog design.Main outcome measuresWomen's perceptions toward the contribution of HEB characteristics to the usefulness and ease of use of those tools to improve their dietary habits were measured.Analyses performedInterviews were audiorecorded, transcribed verbatim, coded, and analyzed through an inductive content analysis using NVivo software.ResultsThe most useful characteristics of type of blog content delivery identified by women were recipes, hyperlinks, and references. Among characteristics of RD blogger's delivery of information, most women reported that interaction between blog readers and the RD blogger created a sense of proximity and of connection that was helpful for improving their dietary behaviors. Women's perceptions toward various characteristics of blog layout and design were also discussed.ConclusionsIncorporating specific characteristics when designing HEBs should be considered by RDs and future research to promote the use of those tools to support dietary behavior change efforts of internet users.
Association between Fruit and Vegetable Consumption and Risk of Hypertension in Middle-Aged and Older Korean Adults J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2017-11-04 Jiwon Kim, Jihye Kim
BackgroundHigh fruit and vegetable (F/V) intake may be beneficial for hypertension prevention. However, a prospective association has not been investigated in a Korean population, and differences exist between typical diets in Korea and those of Western populations.ObjectiveThe aim of this prospective study was to investigate the association between F/V intake and risk of incident hypertension in middle-aged and older Korean adults using the data from the Korean Genome and Epidemiology Study (KoGES).DesignThe KoGES is a large community-based cohort study of Korean adults aged 40 to 69 years, which began in May 2001. Questionnaires on demographic information and lifestyle factors were completed at baseline. Anthropometrics and biochemical measurements were conducted biennially. Fruit and vegetable consumption was assessed with a semiquantitative food frequency questionnaire. Hypertension was defined as a systolic blood pressure≥140 mm Hg or diastolic blood pressure ≥90 mm Hg.Participants and settingA total of 4,257 participants (2,085 men, 2,172 women) without hypertension at baseline were evaluated.Main outcome measuresThe primary outcome was incident hypertension.Statistical analysis performedMultivariate Cox proportional hazard models were used to examine hazard ratios (HRs) and 95% CIs for incident hypertension according to F/V consumption.ResultsDuring the 8-year follow-up, 1,158 participants (606 men and 552 women) developed hypertension. Among men, frequent fruit consumers (≥4 servings/day) had a 56% lower risk of incident hypertension than did infrequent consumers (<1 serving/day) (HR=0.44, 95% CI=0.32 to 0.60, P for trend <0.0001). Among women, frequent fruit consumers had a 67% lower risk of incident hypertension than did infrequent consumers (HR=0.33, 95% CI=0.24 to 0.45, P for trend <0.0001), after adjustment for potential confounders. However, there was no association between vegetable consumption and risk of incident hypertension in either men or women.ConclusionA higher intake of fruit was prospectively associated with a lower risk of incident hypertension in middle-aged and older Korean adults, regardless of sex.
Fresh Fruit and Vegetable Program and Requests for Fruits and Vegetables Outside School Settings J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-01-08 Punam Ohri-Vachaspati, Elizabeth Dachenhaus, Jessie Gruner, Kristina Mollner, Eric B. Hekler, Michael Todd
BackgroundConsumption of fruits and vegetables (F/V) among elementary school-aged children remains inadequate, especially among low-income children. The US Department of Agriculture’s Fresh Fruit and Vegetable Program (FFVP) provides F/V as snacks to children during the school day, outside of school meals. School-based initiatives are successful in changing behaviors in school settings; however, their influence on behaviors outside of schools needs investigation.ObjectiveTo examine whether FFVP participation is associated with F/V requests at stores, self-efficacy to ask for and choose F/V at home, and F/V consumption.DesignCross-sectional study.Participant/settingFourth graders in six classrooms (n=296) from three urban, low-income school districts in Phoenix, AZ, were surveyed during 2015; one FFVP and one non-FFVP school from each district that were similar in school size, percent free/reduced-price meal eligibility, and race/ethnicity of enrolled students were selected.Main outcome measuresChildren’s self-reported F/V requests during shopping, their self-efficacy to ask for and choose F/V at home, and F/V consumption on the previous day (non-FFVP school day) were measured using questions adapted from validated surveys.Statistical analysisMultivariable mixed-effect regression models, adjusting for clustering of students within classes and classes within schools were explored.ResultsIn models adjusting for individual-level factors (ie, age and sex) only, several significant positive associations were observed between school FFVP participation and healthier F/V outcomes. After additionally adjusting for school-level factors (ie, total enrollment and % Hispanic/Latino students) significant associations were observed between school FFVP participation and more requests for vegetables during shopping (P<0.001), higher scores on self-efficacy to choose vegetables at home (P=0.004), stronger preferences for vegetables (P<0.001), and more frequent consumption of fruit (P=0.006).ConclusionsSchool FFVP participation was associated with more requests for vegetables during shopping and higher self-efficacy to make healthy choices at home, suggesting the influence of the FFVP may extend beyond the school day.
No Improvements in Postnatal Dietary Outcomes Were Observed in a Two-Arm, Randomized, Controlled, Comparative Impact Trial among Rural, Southern, African-American Women J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-02-01 Jessica L. Thomson, Lisa M. Tussing-Humphreys, Alicia S. Landry, Melissa H. Goodman
BackgroundSuboptimal diet quality, prevalent among postpartum women, is troubling for mothers and their children because positive relationships between maternal and child diet quality exist.ObjectiveThe primary objective was to determine whether postnatal diet quality scores of participants in the two treatment arms differed or changed over time.DesignDelta Healthy Sprouts was a two-arm, randomized, controlled, comparative impact trial.Participants and settingPregnant women at least 18 years of age, less than 19 weeks pregnant, and residing in three Mississippi counties were recruited between March 2013 and December 2014. Postnatal data was collected from 54 participants between September 2013 and May 2016. The postnatal attrition rates were 17% and 13% for the control and experimental arms.InterventionThe control arm received the Parents as Teachers curriculum, and the experimental arm received a nutrition- and physical activity-enhanced Parents as Teachers curriculum.Main outcome measuresMultiple-pass 24-hour dietary recalls were collected from participants at the postnatal month 1, 4, 6, 8, and 12 visits. Healthy Eating Index-2010 was used to calculate diet quality.Statistical analysis performedLinear mixed models were used to test for treatment, time, and treatment by time (interaction) effects on postnatal dietary outcomes.ResultsControl arm mean (95% confidence limits) total Healthy Eating Index-2010 scores were 36.8 (range=32.5 to 41.1), 36.5 (range=31.9 to 41.1), 40.2 (range=35.7 to 44.8), 39.3 (range=34.7 to 43.9), and 36.4 (range=31.8 to 41.0) at postnatal months 1, 4, 6, 8, and 12, respectively. Corresponding experimental arm scores were 42.3 (range=37.5 to 47.0), 41.6 (range=36.3 to 46.9), 40.2 (range=34.8 to 45.7), 45.8 (range=40.5 to 51.1), and 37.6 (range=32.6 to 42.7), respectively. Experimental scores were significantly higher than control scores across time. No other effects were significant.ConclusionsNeither the standard Parents as Teachers curriculum nor the enhanced Parents as Teachers curriculum was effective at improving the poor diet quality of this cohort of rural, Southern, African-American women during the 12 months following the birth of their infant.
Association between Dietary Glycemic Index and Knee Osteoarthritis: The Korean National Health and Nutrition Examination Survey 2010-2012 J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-02-07 Min Wook So, Sunggun Lee, Seong-Ho Kim
BackgroundObesity and metabolic abnormalities are important risk factors for knee osteoarthritis (KOA). Recent epidemiologic studies have found that a high glycemic index (GI) and glycemic load (GL) diet are associated with a higher risk for metabolic complications and cardiovascular mortality.ObjectiveWe aimed to examine the association between dietary GI, dietary GL, and KOA among Korean adults.DesignThis was a cross-sectional study that analyzed data obtained from the Korean National Health and Nutrition Examination Survey 2010-2012.Participants/settingA total of 9,203 participants (5,275 women) aged ≥50 years were included.Main outcome measuresKOA was defined as the presence of radiographic features of Kellgren-Lawrence grade ≥2. Chronic knee pain was defined as the presence of knee pain for more than 30 days during the past 3 months. Dietary information was collected using a single 24-hour recall method.Statistical analyses performedThe association between the quintiles of dietary GI and dietary GL and knee conditions was analyzed using a multinomial logistic regression analysis adjusting for age, physical activity, obesity, hypertension and diabetes, serum low-density lipoprotein, and total energy intake.ResultsAmong the women, the association between dietary GI and symptomatic KOA was: quintile 1: 1.00 (reference); quintile 2: 1.29 (95% CI 0.87 to 1.92); quintile 3: 1.59 (95% CI 1.11 to 2.28); quintile 4: 1.74 (95% CI 1.21 to 2.51); and quintile 5: 1.77 (95% CI 1.20 to 2.60) (P=0.001). Chronic knee pain without KOA was associated with dietary GI; however, this association was not linear across quintiles. There was no significant association between dietary GI and asymptomatic KOA. Among the men, no significant association was found between dietary GI and any knee conditions. There was no significant association between dietary GL and KOA in both men and women.ConclusionsThere was a significant positive association between dietary GI and symptomatic KOA in women.
Arguments Used in Public Comments to Support or Oppose the US Department of Agriculture’s Minimum Stocking Requirements: A Content Analysis J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-02-13 Lindsey Haynes-Maslow, Lauri Andress, Stephanie Jilcott Pitts, Isabel Osborne, Barbara Baquero, Lisa Bailey-Davis, Carmen Byker-Shanks, Bailey Houghtaling, Jane Kolodinsky, Brian K. Lo, Emily H. Morgan, Emily Piltch, Elaine Prewitt, Rebecca A. Seguin, Alice S. Ammerman
BackgroundIn 2016, the US Department of Agriculture (USDA)’s Supplemental Nutrition Assistance Program (SNAP) Retailer Rule proposed several changes for SNAP-authorized retailers, including: requiring retailers to have at least 85% of their food sales come from items that are not cooked or heated on site before or after purchase; requiring stores to stock seven varieties of qualifying foods from four staple food groups; requiring stores to carry perishable foods in three of the four staple groups; requiring stores to carry six units of qualifying foods at all times (depth of stock); disqualifying multiple ingredient foods and accessory foods from counting toward depth of stock requirements.ObjectivesTo better understand arguments used to support or oppose the USDA’s proposed rule that all SNAP-authorized retailers carry more nutritious foods.DesignWe conducted a qualitative content analysis of a random sample of public comments posted to the US Federal Register (a publicly available database) in response to the USDA’s proposed rule.Participants/settingA random sample of 20% of all public comments submitted by individuals and organizations to the US Federal Register were analyzed (n=303) for this study.ResultsThree main themes were discussed: 1) arguments used in opposition to the rule; 2) arguments used in support of the rule; and 3) facilitators to assist stores in implementing the rule. Some of the subthemes included focusing on definitions used in the rule, reduced food access caused by stores leaving the SNAP program, lack of space and equipment for healthy foods, and the potential for increasing healthy food access.ConclusionsNutrition and dietetics practitioners may be tasked with working with stores to implement healthy changes. Nutrition and dietetics practitioners must understand the role that the USDA has in food policy. In addition, understanding how federal food policy influences the environments in which dietetics professionals’ clients are making food choices is important.
Association between Diet Quality Scores and Risk of Hip Fracture in Postmenopausal Women and Men Aged 50 Years and Older J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-02-15 Teresa T. Fung, Haakon E. Meyer, Walter C. Willett, Diane Feskanich
BackgroundAlthough a number of studies showed a lower risk of hip fractures with high-quality diets, few of them were conducted in the United States.ObjectiveThis prospective analysis examined the association between several diet quality indexes and risk of hip fractures in US men and women.DesignThis is a prospective cohort study.Participants/settingThe participants were 74,446 postmenopausal women from the Nurses’ Health Study and 36,602 men aged 50 years and older from the Health Professionals Follow-Up Study in the United States.Main outcome measureHip fractures were self-reported on biennial questionnaires between 1980-2012 in women, and between 1986-2012 in men.Statistical analysisDiet was assessed every 4 years with a validated food frequency questionnaire. Relative risks were computed for hip fracture by quintiles of the Alternate Mediterranean Diet score (aMed), the Alternate Healthy Eating Index-2010 (AHEI-2010), and the Dietary Approaches to Stop Hypertension score using Cox proportional hazards models, adjusting for potential confounders.ResultsTwo thousand one hundred forty-three incident hip fractures in women and 603 in men were reported during follow-up. A significant inverse trend was observed with the cumulative AHEI-2010 score in women (relative risk comparing extreme quintiles 0.87, 95% CI 0.75 to 1.00; P for trend=0.02). There was also a suggestion of an inverse association with the Dietary Approaches to Stop Hypertension score (P for trend=0.03). In addition, significant inverse trends were observed between all three diet quality scores and hip fractures in women younger than age 75 years but not older women. There was no clear association between diet quality indexes and hip fracture in men.ConclusionsHigher AHEI-2010 scores were associated with a lower risk of hip fractures in US women. The inverse associations with diet quality may be more apparent among those younger than age 75 years.
Early Childhood Vegetable, Fruit, and Discretionary Food Intakes Do Not Meet Dietary Guidelines, but Do Show Socioeconomic Differences and Tracking over Time J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-03-01 Alison C. Spence, Karen J. Campbell, Sandrine Lioret, Sarah A. McNaughton
BackgroundDietary intakes of young children are likely to be important determinants of their short- and long-term health, yet there are few longitudinal dietary studies of this age group, and no previous assessments of diets before age 2 years compared with national dietary guidelines.ObjectiveThis study aimed to compare vegetable, fruit, and discretionary food intakes of children aged 9 months to 5 years to dietary guidelines, and to assess differences in intakes by socioeconomic status and tracking of intakes across early childhood.DesignThis study analyzed longitudinal data from the Melbourne Infant Feeding Activity and Nutrition Trial Program early childhood lifestyle intervention trial, and is the first study to compare diets of children younger than age 2 years to national dietary guidelines.Participants/settingParticipants were 467 children in Melbourne, Australia, aged 4 months at baseline (study conducted 2008-2015).Main outcome measuresMultiple 24-hour recalls with parents were conducted at child ages 9 months, 1.5 years, 3.5 years, and 5 years.Statistical analyses performedIntakes of vegetables, fruits, and discretionary foods were compared with Australian Dietary Guidelines. Differences by socioeconomic status and tracking of intakes of each food group were assessed by multivariable linear regression.ResultsFew children (<10%) met guidelines for discretionary food intakes at any age. Most children (≥90%) met vegetable and fruit guidelines at 9 months, but thereafter rates of adequate intakes reduced substantially. Children of higher socioeconomic status consumed diets closer to guidelines for most food groups at most ages. Tracking of intakes was apparent across ages, with the strongest and most consistent tracking for discretionary foods.ConclusionsThis study shows that diets of Australian children participating in this lifestyle intervention trial were suboptimal from early life. The evidence of differences by socioeconomic status and tracking from age 9 months, particularly for discretionary foods, highlights the importance of research and action to support appropriate introduction of complementary foods during the first year of life, and of focusing these efforts on disadvantaged groups.
Contribution of Beverage Selection to the Dietary Quality of the Packed Lunches Eaten by Preschool-Aged Children J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-03-01 Maria Jose Romo-Palafox, Nalini Ranjit, Sara J. Sweitzer, Cindy Roberts-Gray, Courtney E. Byrd-Williams, Margaret E. Briley, Deanna M. Hoelscher
BackgroundSweet drinks early in life could predispose to lifelong consumption, and the beverage industry does not clearly define fruit drinks as part of the sweet drink category.ObjectivesTo ascertain the relationship between beverage selection and dietary quality of the lunches packed for preschool-aged children evaluated using the Healthy Eating Index-2010.MethodsFoods packed by parents (n=607) were observed at 30 early care and education centers on two nonconsecutive days. Three-level regression models were used to examine the dietary quality of lunches by beverage selection and the dietary quality of the lunch controlling for the nutrient composition of the beverage by removing it from the analysis.ResultsFruit drinks were included in 25% of parent-packed lunches, followed by 100% fruit juice (14%), milk (14%), and flavored milk (3.7%). Lunches with plain milk had the highest Healthy Eating Index-2010 scores (59.3) followed by lunches with 100% fruit juice (56.9) and flavored milk (53.2). Lunches with fruit drinks had the lowest Healthy Eating Index-2010 scores at 48.6. After excluding the nutrient content of the beverage, the significant difference between lunches containing milk and flavored milk persisted (+5.5), whereas the difference between fruit drinks and 100% fruit juice did not.ConclusionsDietary quality is associated with the type of beverage packed and these differences hold when the lunch is analyzed without the nutrient content of the beverage included.
“Take Me through the History of Your Weight”: Using Qualitative Interviews to Create Personalized Weight Trajectories to Understand the Development of Obesity in Patients Preparing for Bariatric Surgery J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-03-16 Amanda I. Lynch, Elizabeth McGowan, Kerstyn C. Zalesin
BackgroundObesity can develop during any life stage. Understanding the contexts within which obesity develops can inform our understanding of the disease and help tailor interventions specific to life stages.ObjectiveUsing life-course theory as a guiding framework, this study aimed to explain the development of obesity in bariatric surgery patients by creating personalized weight trajectories.DesignQualitative methods using semistructured interviews were used to uncover participants’ experiences with and explanations for the development of obesity. A grounded theory approach using the constant comparative method was used to analyze transcripts for categories and themes.Participants/settingThirty pre-bariatric surgery patients (24 women, 6 men) were recruited from a bariatric surgery center; 25 participants were available for follow-up. Participants were interviewed before surgery and at 6 and 12 months postsurgery.ResultsFour weight history groups were created based on patterns of weight changes from adolescence through adulthood: Always Heavy, Late Peak, Steady Progression, and Weight Cycling. Participants’ explanations for weight changes centered around themes of transitions and life-course events or stressors. Differences in the weight history groups could be explained by the timing of transitions, life events, and responses to stress.ConclusionsThe development of obesity does not follow the same pattern for all individuals. Weight gain patterns can be explained by the timing of life-course events, stressors, and the type and effects of environmental transitions. Weight management counseling should include strategies tailored to an individual’s current life-stage and circumstance, but also acknowledge previous responses to transitions and stressors.
Eating School Meals Daily Is Associated with Healthier Dietary Intakes: The Healthy Communities Study J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-03-17 Lauren E. Au, Klara Gurzo, Wendi Gosliner, Karen L. Webb, Patricia B. Crawford, Lorrene D. Ritchie
BackgroundResearch on the association between school meal consumption and overall dietary intake post-Healthy Hunger-Free Kids Act implementation is limited.ObjectiveThis study examines the association between frequency of participating in the National School Lunch and School Breakfast Programs and children’s dietary intakes.DesignThe Healthy Communities Study was a cross-sectional observational study conducted between 2013 and 2015.Participants and settingUS children aged 4 to 15 years (n=5,106) were included.Main outcome measuresDietary measures were assessed using the National Health and Nutrition Examination Survey Dietary Screener Questionnaire. Dietary intake included fruit and vegetables, fiber, whole grains, dairy, calcium, total added sugar, sugar-sweetened beverages, and energy-dense foods of minimal nutritional value.Statistical analysisMultivariate statistical models assessed associations between frequency of eating school breakfast or lunch (every day vs not every day) and dietary intake, adjusting for child- and community-level covariates.ResultsChildren who ate school breakfast every day compared with children who ate 0 to 4 days/wk, reported consuming more fruits and vegetables (0.1 cup/day, 95% CI: 0.01, 0.1), dietary fiber (0.4 g/day, 95% CI: 0.2, 0.7), whole grains (0.1 oz/day, 95% CI: 0.05, 0.1), dairy (0.1 cup/day, 95% CI: 0.05, 0.1), and calcium (34.5 mg/day, 95% CI: 19.1, 49.9). Children who ate school lunch every day, compared with those who ate less frequently, consumed more dairy (0.1 cup/day, 95% CI: 0.1, 0.2) and calcium (32.4 mg/day, 95% CI: 18.1, 46.6). No significant associations were observed between school meal consumption and energy-dense nutrient-poor foods or added sugars.ConclusionsEating school breakfast and school lunch every day by US schoolchildren was associated with modestly healthier dietary intakes. These findings suggest potential nutritional benefits of regularly consuming school meals.
Comparison of the Dietary Antioxidant Profiles of 21 a priori Defined Mediterranean Diet Indexes J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-03-24 Angela Hernández-Ruiz, Belén García-Villanova, Eduardo Guerra-Hernández, Pilar Amiano, María-José Sánchez, Miren Dorronsoro, Esther Molina-Montes
BackgroundThe Mediterranean Diet (MD) is a dietary pattern that features a high quotient of antioxidant-rich foods. Differences in the level of dietary antioxidants intake reflected by different MD indexes has received little research attention.ObjectiveThe purpose of this study was to compare the dietary antioxidant profile of 21 a priori defined indexes of adherence to the MD.DesignA cross-sectional study.Participants/settingA total of 14,756 participants belonging to two Spanish European Prospective Investigation into Cancer and Nutrition cohorts, aged 32 to 69 years, recruited between 1992 and 1996, were included.Main outcome measureParticipants provided information on diet through a validated diet history questionnaire. Antioxidants (vitamin C, beta carotene and α-tocopherol), total antioxidant capacity, total polyphenols, flavonoids, and polyphenol antioxidant content score were estimated using different food composition databases. Twenty-one MD indexes were operationalized.Statistical analysisSpearman correlation coefficients between the indexes were calculated and hierarchical clustering was applied to identify cluster groups. Weighted kappa statistic was estimated to value the scoring agreements between indexes. Antioxidant profiles between the MD indexes were compared based on geometric mean intakes. The relationship between each MD index with the components of the antioxidant profile was evaluated using linear multivariable regression analysis.ResultsCorrelation patterns between the MD indexes showed that about half of the indexes were moderately-to-weakly correlated with each other (rho<0.5). The main cluster groups derived denoted the high-, moderate-, and low-correlated MD indexes. Three MD indexes (MD pattern-2002, Prevention with MD, and Alternate MD index) presented the highest mean intakes of antioxidant vitamins, total antioxidant capacity, total polyphenols, flavonoids, and polyphenol antioxidant content score. These and other indexes (mainly those belonging to the MD Scale group) captured higher intake levels of dietary antioxidants overall.ConclusionsThe level of dietary antioxidant intake that is captured through the different MD indexes differed due to the variation in their construction. Study results also suggest that some MD indexes reflect a higher antioxidant profile.
<img height="20" border="0" style="vertical-align:bottom" width="23" alt="Online Extra" title="Online Extra" src="https://origin-ars.els-cdn.com/content/image/1-s2.0-S2212267218302818-oextra_o.gif">Validation of a Questionnaire to Measure Fruits and Vegetables Selected and Consumed at School Lunch among Second- and Third-Grade Students J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-05-31 Matthew M. Graziose, Randi L. Wolf, Pamela A. Koch, Heewon L. Gray, Isobel R. Contento
BackgroundInterventions designed to encourage fruit and vegetable (F/V) consumption within schools are increasingly common. Thus, there is a need for valid, practical dietary assessment instruments to evaluate their effectiveness.ObjectiveThe aim of this study was to examine the validity of a group-administered, paper-and-pencil questionnaire to assess F/V selection and consumption at school lunch relative to digital photography.DesignThis was a five-phase, method-comparison study in which the questionnaire was iteratively modified between each phase.Participants/settingThe study examined sets of questionnaires and photographs of lunch trays (n=1,213) collected on 44 days between May 2015 and June 2016 among second-grade students from three New York City schools (phases 1 to 4) and second- and third-grade students from 20 schools across eight states (phase 5).Main outcome measuresOutcomes assessed were selection, amount eaten, preference, and intention to consume F/V.Statistical analyses performedValidity was assessed by percent agreement (categorized as “match, omission, or intrusion” for items on or off tray and “match, overestimation, or underestimation” for amount eaten), Spearman correlation coefficients, and intraclass correlation coefficients (ICC).ResultsThe total match rate for items on tray was substantial (phases 1 to 5: 83%, 84%, 92%, 93%, and 89%), with items more frequently intruded than omitted. For amounts eaten, the total match rates were moderate, but generally improved throughout the study (phases 1 to 5: 65%, 64%, 83%, 83%, and 76%), with overestimations more frequent than underestimations. There was good correspondence between methods in the estimates of amount eaten in a quantitative, cup equivalent amount (fruit ICC=0.61; vegetables ICC=0.64). Significant differences (α=.05) were not observed between second- and third-grade students, respectively, in the match rate for fruits (86% and 89%) or vegetable (89% and 86%) items on tray or fruit (69% and 73%) and vegetables (74% and 76%) amount eaten. Excellent correlations were observed between amount eaten and preference for fruit (r=0.91) and vegetables (r=0.93).ConclusionsThe questionnaire offers a feasible, valid instrument for assessing F/V selection and consumption among elementary students in schools participating in the National School Lunch Program. Additional research is recommended to test the instrument’s sensitivity and to reproduce these findings using an alternative reference method, such as direct observations.
Changes in Overall Diet Quality in Relation to Survival in Postmenopausal Women with Breast Cancer: Results from the Women’s Health Initiative J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-05-30 Yangbo Sun, Wei Bao, Buyun Liu, Bette J. Caan, Dorothy S. Lane, Amy E. Millen, Michael S. Simon, Cynthia A. Thomson, Lesley F. Tinker, Linda V. Van Horn, Mara Z. Vitolins, Linda G. Snetselaar
Background Lifestyle factors are important for cancer survival. However, empirical evidence regarding the effects of dietary changes on mortality in breast cancer survivors is sparse. Objective The objective was to examine the associations of changes in overall diet quality, indicated by the Healthy Eating Index (HEI)-2010 score, with mortality in breast cancer survivors. Design This was a prospective cohort study from September 1993 through September 30, 2015. Participants/setting This study included 2,295 postmenopausal women who were diagnosed with invasive breast cancer and completed a food frequency questionnaire both before and after the diagnosis of breast cancer in the Women’s Health Initiative. Main outcome measures The HEI-2010 score (maximum score of 100) was calculated based on consumption of 12 dietary components. The outcomes were mortality from all causes, breast cancer, and causes other than breast cancer. Statistical analyses performed Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios of mortality from all causes, breast cancer, and other causes. Results Over 12 years of follow-up, 763 deaths occurred. Compared with women with relatively stable diet quality (±14.9% change in HEI-2010 score), women who decreased diet quality (≥15% decrease in HEI-2010 score) had a higher risk of death from breast cancer (adjusted hazard ratio 1.66, 95% CI 1.09 to 2.52). Increased diet quality (≥15% increase in HEI-2010 score) was not significantly associated with lower risk of death. These associations persisted after additional adjustment for change in body mass index. Conclusions Among women with breast cancer, decreased diet quality after breast cancer diagnosis was associated with higher risk of death from breast cancer.
New Equations to Predict Body Fat in Asian-Chinese Adults Using Age, Height, Skinfold Thickness, and Waist Circumference J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-05-08 Christiani Jeyakumar Henry, Shalini D/O Ponnalagu, Xinyan Bi, Sze-Yen Tan
Background Adiposity is an independent predictor of metabolic disease. However, highly accurate body fat assessment is not routinely done due to limited access to expensive and labor-intensive methods. Objective The aim of the study was to develop body fat prediction equations for Asian-Chinese adults using easily attainable anthropometric measurements. Design Prediction equations of body fat were developed using anthropometric and skinfold thickness measurements obtained from a cross-sectional study. These new equations were then validated using baseline data from an independent randomized controlled study. Participants/setting Healthy participants with no major diseases and not taking long-term medications were recruited in an ongoing cross-sectional study that began in June 2014 (n=439, 170 males, 269 females), as well as a randomized controlled trial (n=108, 58 males, 50 females) conducted from January 2013 to October 2014. Both the studies were conducted at Clinical Nutrition Research Center located in Singapore. Main outcome measures Data used to develop and validate equations were from two original studies that assessed body fat by dual-energy x-ray absorptiometry, age, waist circumference, height, and biceps and triceps skinfolds. Statistical analysis performed Sex-specific percent body fat prediction equations were developed using stepwise regression with Akaike Information Criterion on the cross-sectional data. The equations were then validated using data from the randomized controlled study and also compared against Asian-specific Davidson equations. Results The best body fat prediction model (R2=0.722, standard error of estimation=2.97 for females; R2=0.815, standard error of estimation=2.49 for males) for both sexes included biceps and triceps skinfolds, waist circumference, age, and height. The new equations developed resulted in modest discrepancies in body fat of 1.8%±2.7% in males (P<0.001) and 0.7%±3.1% in females (P=0.125; not significant) compared with the Asian-specific Davidson equations (−7.4%±3.2% [P<0.001] and −7.4%±2.7% [P<0.001], respectively). Conclusions Sex-specific equations to predict the percent body fat of Asian-Chinese adults with a higher degree of accuracy were developed. Ease of use in both field and clinical settings will be a major advantage.
Trends in Dietary Sodium from Food Sources in Australian Children and Adolescents from 2007 to 2011/12 J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-05-03 Carley A. Grimes, Ewa A. Szymlek-Gay, Caryl A. Nowson
Background In western countries, most children eat more sodium than is recommended. In Australia in 2009, voluntary sodium reformulation targets were adopted for nine categories of processed foods, but the impact of this initiative on children’s sodium intake has not been assessed. Objective To compare sodium consumption of Australian children aged 2 to 16 years from 2007 to 2011/12. Design Cross-sectional analysis of data from the 2007 Children’s Nutrition and Physical Activity Survey (n=4,487) and the 2011/12 National Nutrition and Physical Activity Survey (n=2,548). Participants/setting A nationally representative sample of 6,705 Australian children aged 2 to 16 years who provided plausible 24-hour dietary recall data according to Goldberg cutoffs for misreporting of energy intake. Main outcome measures Mean intakes of energy, sodium, and sodium density (mg/1,000 kcal) were assessed via one 24-hour dietary recall; measurement error models with up to two 24-hour dietary recalls were used to estimate usual sodium intake and the proportion of children exceeding the age-specific upper level for sodium. Statistical analyses preformed Statistical analysis incorporated survey weights and accounted for the complex survey design. Two-sample t-tests and two-sample test of proportions were used to assess differences in continuous and categorical variables between survey years. Results Dietary sodium declined by 8% between 2007 and 2011/12 (−188±SE 31 mg/day; P<0.001), and this was in conjunction with a 5% reduction in energy intake (98±19 kcal/day; P<0.001). When stratified by age group, significant reductions in sodium intake remained across all four age groups (ie, 2-3 years, 4-8 years, 9-13 years, and 14-16 years); similarly, with the exception of 2- to 3-year-old children, reductions in energy intake were observed across all other age groups. Overall sodium density declined by 2% (−29 mg/1,000 kcal/day; P=0.01); however, in age subgroup analysis the decline in sodium density only remained among children aged 2 to 3 years. The upper level for sodium was exceeded by 94% or more children in 2007 and 78% or more in 2011/2012. Conclusion Although results suggest a small reduction in reported sodium intake over 5 years, most children in 2011/12 had a sodium intake that exceeded the recommended upper level. Ongoing efforts to reduce sodium in the diets of Australian children are required.
Managing Complexity in Evidence Analysis: A Worked Example in Pediatric Weight Management J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-05-02 James Scott Parrott, Beverly Henry, Kyle L. Thompson, Jane Ziegler, Deepa Handu
Nutrition interventions are often complex and multicomponent. Typical approaches to meta-analyses that focus on individual causal relationships to provide guideline recommendations are not sufficient to capture this complexity. The objective of this study is to describe the method of meta-analysis used for the Pediatric Weight Management (PWM) Guidelines update and provide a worked example that can be applied in other areas of dietetics practice. The effects of PWM interventions were examined for body mass index (BMI), body mass index z-score (BMIZ), and waist circumference at four different time periods. For intervention-level effects, intervention types were identified empirically using multiple correspondence analysis paired with cluster analysis. Pooled effects of identified types were examined using random effects meta-analysis models. Differences in effects among types were examined using meta-regression. Context-level effects are examined using qualitative comparative analysis. Three distinct types (or families) of PWM interventions were identified: medical nutrition, behavioral, and missing components. Medical nutrition and behavioral types showed statistically significant improvements in BMIZ across all time points. Results were less consistent for BMI and waist circumference, although four distinct patterns of weight status change were identified. These varied by intervention type as well as outcome measure. Meta-regression indicated statistically significant differences between the medical nutrition and behavioral types vs the missing component type for both BMIZ and BMI, although the pattern varied by time period and intervention type. Qualitative comparative analysis identified distinct configurations of context characteristics at each time point that were consistent with positive outcomes among the intervention types. Although analysis of individual causal relationships is invaluable, this approach is inadequate to capture the complexity of dietetics practice. An alternative approach that integrates intervention-level with context-level meta-analyses may provide deeper understanding in the development of practice guidelines.
Adjustment Factors Can Improve Estimates of Food Group Intake Assessed Using a Short Dietary Assessment Instrument J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-05-01 Gilly A. Hendrie, Megan A. Rebuli, Rebecca K. Golley, Manny Noakes
Background Methods to address misreporting associated with short dietary assessment instruments are needed. Objective Our objective was to develop and evaluate the direct and indirect validity of adjustment factors applied to a short dietary assessment instrument to improve estimates of usual consumption of core and discretionary food and beverage intake. Design Validation of the Short Food Survey relative to 24-hour recalls was performed. The Short Food Survey requires individuals to report their usual intake of fruit, vegetables, grains, meat, dairy, and discretionary choices in multiples of standard servings. Adjustment factors were developed based on a ratio (usual portion size estimated from national data to standard serving size). The estimates of food group intakes (unadjusted and adjusted) were compared to 24-hour recalls. Participants/setting Three population samples were used in this study. The direct validation used data from 61 Australian adults (collected 2013–2014). The indirect validation compared data from the 2011–2013 Australian National Nutrition and Physical Activity Survey (n=9,435) to a sample of 145,975 who completed the Short Food Survey in a format that is freely available online (2015–2016). Main outcome measures Food group intake (in servings) was measured. Statistical analyses performed Descriptive and inferential statistical analyses were conducted. Results Direct validation showed the adjustment factors improved the survey-derived estimates of intake for all food groups except grain foods. For grains, the mean difference went from –0.6 servings to +1.2 to 1.5 servings. The absolute difference in food group intake between the adjusted Short Food Survey and recalls remained statistically significant for fruit, meat, dairy, and grains, but was not different for vegetables and discretionary foods. The indirect validation showed that the adjusted estimates of intake from the online Short Food Survey were closer to the population estimates reported by 24-hour recall for all food groups except meat. Conclusions Adjustment factors can improve estimates of food group intake assessed using a short dietary assessment instrument for some but not all food groups.
Understanding Customers: The Jobs to Be Done Theory Applied in the Context of a Rural Food Pantry J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-04-30 J. Mitchell Vaterlaus, Natalie Martineau Cottle, Emily Vaterlaus Patten, Robyn Gibbons
Background Food insecurity, and particularly rural food insecurity, has unique challenges associated with it. Understanding the customer or patron needs is increasingly important in resolving this national concern. The Jobs to Be Done Theory posits that when considering customers, it is beneficial to move past demographic profiling and focus on what the customer wants to accomplish by using a particular product or service. Objective This qualitative study aimed to determine customers’ jobs to be done at a rural food pantry. In addition, it seeks to demonstrate the application of contemporary management theory to dietetics practice. Design A case study approach was used in this study. Case study data collection procedures included six male and six female food pantry patrons in Montana completing in-depth, audio-recorded interviews and surveys. Each person’s interview and survey were constructed into individual case descriptions; the case descriptions were analyzed using uniform categories determined by researchers. To identify themes in the holistic case, word tables were created for each uniform category and assessed for key themes representing patrons’ experiences. Results The key themes that emerged were the customer in context, customers’ food relief needs, connecting with customers, and barriers to utilization. Conclusions The application of Jobs to Be Done Theory to rural food pantry customers demonstrates that demographic segmentation does not capture the social, emotional, and functional dimensions for this sample. Investigation of customer experiences, circumstances, and obstacles is important for improving dietetics services.
Measuring Micro-Level Effects of a New Supermarket: Do Residents Within 0.5 Mile Have Improved Dietary Behaviors? J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2017-08-08 Stephanie Rogus, Jessica Athens, Jonathan Cantor, Brian Elbel
Background Local and national policies to encourage supermarket opening or expansion are popular strategies for improving access to healthy food for residents in neighborhoods lacking these types of stores, yet few evaluations of such initiatives exist. Objective Our aim was to test whether a newly opened supermarket in the Bronx, NY, changed household availability of healthy and unhealthy food items and reported daily consumption of these items among respondents residing in close proximity (≤0.5 mile) to the new supermarket. Design This quasi-experimental study evaluated changes in purchasing and consumption habits of residents within 0.5 mile of the new supermarket as compared to residents living more than 0.5 mile from the supermarket. Data were collected through street intercept surveys at three different times: once before the store opened (March to August 2011) and in two follow-up periods (1 to 5 months and 13 to 17 months after the store opened). This study analyzed a subset of successfully geocoded resident intersections from the larger study. Participants/setting We surveyed 3,998 residents older than the age of 18 years in two Bronx neighborhoods about their food-purchasing behaviors before the store opened and in two follow-up periods. Responses from residents whose intersections were successfully geocoded (N=3,378) were analyzed to examine the consumption and purchasing behaviors of those in close proximity to the new store. Intervention A new supermarket opened in a low-access neighborhood in the Bronx with the help of financial incentives through New York City’s Food Retail Expansion to Support Health (FRESH) program. Main outcome measures The primary outcome evaluated was the change in percent of respondents reporting that the following food items were “always available” in the home: milk, fruit juice, soda, pastries, packaged snacks, fruits, and vegetables. As a secondary outcome, we explored changes in self-reported daily servings of these items. Statistical analysis performed A difference-in-difference analysis was performed, controlling for age, education, marital status, income, sex, race, and ethnicity. Results Residents within 0.5 mile of the store had increased household availability of both healthy and unhealthy foods. After the introduction of the supermarket, the percent of residents in close proximity to the store who reported always having produce available in the home increased by 8.8% compared to those living >0.5 mile from the store in the first post-period and by 10.6% compared to those living >0.5 mile from the store in the second post-period. A similar positive increase in household availability of salty snacks and pastries was observed. Residents living in close proximity also reported greater consumption of healthy foods like produce and water, and lower intake of soft drinks and pastries. Conclusions Given the financial support at the national and local levels to encourage supermarket development and expansion in high-need communities, it is imperative to evaluate the impact of such initiatives. Although the findings have so far been equivocal, our findings give weight to the argument that, at a micro-level, the siting of a new supermarket can indeed impact local purchasing and consumption behavior. Although purchasing for both healthy and unhealthy food items increased, reported consumption showed an increase in servings of healthy items (water, vegetables, and fruit) and a decrease in servings of unhealthy foods (soft drinks, salty snacks, and pastries).
Does the Transformation of Dietitians from Counseling to Therapy Also Apply to the Physical and Therapeutic Environment? A Case Study of Israeli Practice J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2017-08-17 Anat Gesser-Edelsburg, Yael Birman
Background Lifestyle change can be influenced through effective interaction between care receiver and care provider. The physical environment where the interaction occurs can affect the dynamics of long-term therapeutic treatment. There have been no studies on the perception of the physical environment in nutritional treatment. Objective Our aim was to ascertain the impact of the physical environment on the dynamics and communication between dietitian and patient based on perceptions of dietitians. Design We conducted qualitative constructivist phenomenological research. Participants In-depth interviews (n=10) and eight focus groups (n=62) were held with dietitians who offer treatment in a physical environment designed according to the medical model and/or in a physical dynamic environmental design according to the dynamic model. Results Most dietitians in Israel treat their patients in a physical environment arranged according to the medical model. The participants reported that the physical environment affects the interaction. However, the idea of transforming the physical environment according to the dynamic model raised reservations. Barriers include upsetting therapeutic boundaries, challenging professional authority, and lack of therapeutic tools suitable for the change. Conclusions Changes in the spatial design in which the therapeutic interaction occurs might support the dietitians' transformation from counseling into therapy. The barriers toward such change suggest that professional training is needed to enable dietitians to overcome them. We recommend conducting further research to evaluate the current physical environment, as well as raising dietitians’ awareness and training them to work in the new environment, reflecting a counseling/therapeutic mindset. These changes should be followed by additional research among practitioners to report on their effects.
Retailer-Led Sugar-Sweetened Beverage Price Increase Reduces Purchases in a Hospital Convenience Store in Melbourne, Australia: A Mixed Methods Evaluation J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2017-09-01 Miranda R. Blake, Anna Peeters, Emily Lancsar, Tara Boelsen-Robinson, Kirstan Corben, Christopher E. Stevenson, Claire Palermo, Kathryn Backholer
Background Limited evidence has been gathered on the real-world impact of sugar-sweetened beverage price changes on purchasing behavior over time or in community-retail settings. Objective Our aim was to determine changes in beverage purchases, business outcomes, and customer and retailer satisfaction associated with a retailer-led sugar-sweetened beverage price increase in a convenience store. We hypothesized that purchases of less-healthy beverages would decrease compared to predicted sales. Design A convergent parallel mixed methods design complemented sales data (122 weeks pre-intervention, 17 weeks during intervention) with stakeholder interviews and customer surveys. Participants/setting Electronic beverage sales data were collected from a convenience store in Melbourne, Australia (August through November 2015). Convenience store staff completed semi-structured interviews (n=4) and adult customers exiting the store completed surveys (n=352). Intervention Beverages were classified using a state government framework. Prices of “red” beverages (eg, nondiet soft drinks, energy drinks) increased by 20%. Prices of “amber” (eg, diet soft drinks, small pure fruit juices) and “green” beverages (eg, water) were unchanged. Main outcome measures Changes in beverage volume, item sales, and revenue during the intervention were compared with predicted sales. Statistical analyses Sales data were analyzed using time series segmented regression while controlling for pre-intervention trends, autocorrelation in sales data, and seasonal fluctuations. Results Beverage volume sales of red (−27.6%; 95% CI −32.2 to −23.0) and amber (−26.7%; 95% CI −39.3 to −16.0) decreased, and volume of green beverages increased (+26.9%; 95% CI +14.1 to +39.7) in the 17th intervention week compared with predicted sales. Store manager and staff considered the intervention business-neutral, despite a small reduction in beverage revenue. Fifteen percent of customers noticed the price difference and 61% supported the intervention. Conclusions A 20% sugar-sweetened beverage price increase was associated with a reduction in their purchases and an increase in purchases of healthier alternatives. Community retail settings present a bottom-up approach to improving consumer beverage choices.
Child Feeding Style and Dietary Outcomes in a Cohort of Latino Farmworker Families J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2017-09-29 Edward H. Ip, Sarah A. Marshall, Thomas A. Arcury, Cynthia K. Suerken, Grisel Trejo, Joseph A. Skelton, Sara A. Quandt
Background The high level of obesity in Latino children, especially in farmworker families, may be partly attributed to feeding styles of parents. Feeding styles used in Latino farmworker families have not been well characterized. Objective This study sought to identify and describe feeding styles used by mothers in farmworker families with 2.5- to 3.5-year-old children, describe how styles change over time, and characterize the relationship of feeding styles to dietary outcomes and measures of overweight and obesity. Design This was a longitudinal cohort study, with families participating for a 2-year period; surveys were administered to mothers with varying frequency depending on the instrument, and dietary measurements were collected at baseline and 12 and 24 months. Participants/setting Eligible participants were self-identified Latino women with a co-resident child aged 2.5 to 3.5 years old and at least one household member engaged in farm work during the previous year. The sample included 248 farmworker families enrolled between 2011 and 2012 in the Niños Sanos study, a longitudinal investigation of Latino mothers and their young children in rural North Carolina. Eleven families provided incomplete dietary data, so the analysis included 237 families. Fifteen families were lost to follow-up and 12 withdrew during the course of the study. Main outcome measures Feeding style was assessed using items from the Caregiver’s Feeding Style Questionnaire, selected dietary components were assessed using the Revised Children’s Diet Quality Index, and weight outcomes were determined using body mass index-for-age percentile. Performance on the Caregiver’s Feeding Style Questionnaire items was used to assign mothers to one of four feeding style states. Statistical analyses performed Exploratory factor analysis was conducted on baseline data to verify the replicability of the factor structure of the instrument Caregiver’s Feeding Style Questionnaire. Hidden Markov Model analysis was used to delineate different subtypes of feeding style. Multivariable mixed-effects regression models were used to assess the impact of feeding style on selected dietary components, energy intake, and body mass index-for-age percentile. Results Four distinct states emerged from the Hidden Markov Model: low parent-centered (PC)/moderate child-centered (CC) feeding style (28% at baseline), high PC/CC without physical control (24%), high PC/CC (26%), and moderate PC/CC (22%). The low PC/moderate CC state increased in prevalence over time. Compared to high PC/CC, the low PC/moderate CC state was associated with greater intake of added sugars (P<0.01), lower intake of whole grains and vegetables (P<0.01), and lower overall diet quality (P<0.05). Children in low PC/moderate CC also had higher mean body mass index percentiles (76.2 percentile vs 66.7 percentile in high PC/CC; P<0.001). Conclusions High PC feeding along with high CC feeding is associated with improved diet quality and weight outcomes for children in the study.
A Low Glycemic Index and Glycemic Load Diet Decreases Insulin-like Growth Factor-1 among Adults with Moderate and Severe Acne: A Short-Duration, 2-Week Randomized Controlled Trial J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-04-22 Jennifer Burris, James M. Shikany, William Rietkerk, Kathleen Woolf
Background A high glycemic index (GI) and glycemic load (GL) diet may stimulate acne proliferative pathways by influencing biochemical factors associated with acne. However, few randomized controlled trials have examined this relationship, and this process is not completely understood. Objective This study examined changes in biochemical factors associated with acne among adults with moderate to severe acne after following a low GI and GL diet or usual eating plan for 2 weeks. Design This study utilized a parallel randomized controlled design to compare the effect of a low GI and GL diet to usual diet on biochemical factors associated with acne (glucose, insulin, insulin-like growth factor [IGF]-1, and insulin-like growth factor binding protein [IGFBP]-3) and insulin resistance after 2 weeks. Participants Sixty-six participants were randomly allocated to the low GI and GL diet (n=34) or usual eating plan (n=32) and included in the analyses. Main outcome measures The primary outcomes were biochemical factors of acne and insulin resistance with dietary intake as a secondary outcome. Statistical analyses Independent sample t tests assessed changes in biochemical factors associated with acne, dietary intake, and body composition pre- and postintervention, comparing the two dietary interventions. Results IGF-1 concentrations decreased significantly among participants randomized to a low GI and GL diet between pre- and postintervention time points (preintervention=267.3±85.6 mg/mL, postintervention=244.5±78.7 ng/mL) (P=0.049). There were no differences in changes in glucose, insulin, or IGFBP-3 concentrations or insulin resistance between treatment groups after 2 weeks. Carbohydrate (P=0.019), available carbohydrate (P<0.001), percent energy from carbohydrate (P<0.001), GI (P<0.001), and GL (P<0.001) decreased significantly among participants following a low GI/GL diet between the pre- and postintervention time points. There were no differences in changes in body composition comparing groups. Conclusions In this study, a low GI and GL diet decreased IGF-1 concentrations, a well-established factor in acne pathogenesis. Further research of a longer duration should examine whether a low GI and GL diet would result in a clinically meaningful difference in IGF-1 concentrations leading to a reduction in acne. This trial was registered at clinicaltrials.gov as NCT02913001.
Inuit Country Food Diet Pattern Is Associated with Lower Risk of Coronary Heart Disease J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-04-21 Xue Feng Hu, Tiff-Annie Kenny, Hing Man Chan
Background Inuit have experienced a rapid transition in diet and lifestyle over the past several decades, paralleled by the emergence of chronic diseases such as obesity, diabetes, and hypertension. Objective To identify contemporary dietary patterns among Inuit and investigate their association with cardiovascular disease outcomes. Design This was an association study in a cross-sectional population health and nutrition survey. Participants The participants included 1,570 adults (aged ≥18 years) from Nunavut in the International Polar Year Inuit Health Survey 2007-2008 who completed diet/health questionnaires and provided blood samples. Main outcome measures Outcomes measured included the prevalence of coronary heart disease, myocardial infarction, stroke, hyperlipidemia, and hypertension. Statistical analyses performed Principal component analysis was used to derive dietary patterns based on the consumption of nine market food groups and four country food groups reported in 24-hour dietary recalls. The associations between cardiovascular outcomes and identified dietary patterns were examined with logistic regression. Results Three dietary patterns were identified: market food, country food–fat, and country food–fish. The market food diet, characterized by high consumption of market-bought meat, cereals, vegetables, and added oil, was associated with elevated prevalence of coronary heart disease, myocardial infarction, and hypertension (odds ratio [OR] 1.44, 95% CI 0.82 to 2.51; OR 2.27, 95% CI 0.88 to 5.83; and OR 1.36, 95% CI 0.88 to 2.09). The country food–fish diet, characterized by high fish consumption and low sugar and sweets intake, was inversely associated with the prevalence of coronary heart disease, myocardial infarction, stroke, and hyperlipidemia (OR 0.78, 95% CI 0.43 to 1.37; OR 0.46, 95% CI 0.18 to 1.20; OR 0.34, 95% CI 0.07 to 2.13; and OR 0.69, 95% CI 0.39 to 1.22). The country food–fat diet, characterized by high marine mammal and added fat intake, was positively associated with the prevalence of coronary heart disease. Conclusions A diet featuring high food variety, high fish intake, and low sugar intake was negatively associated with the prevalence of cardiovascular outcomes among Inuit.
Body Composition Measurement in Bronchiectasis: Comparison between Bioelectrical Impedance Analysis, Skinfold Thickness Measurement, and Dual-Energy X-ray Absorptiometry before and after Pulmonary Rehabilitation J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-04-12 Esperanza Doña, Casilda Olveira, Francisco Javier Palenque, Nuria Porras, Antonio Dorado, Rocío Martín-Valero, Ana M. Godoy, Francisco Espíldora, Victoria Contreras, Gabriel Olveira
Background In individuals with bronchiectasis, fat-free mass depletion may be common despite a low prevalence of underweight and is considered a risk factor for increased morbidity and mortality. Techniques to adequately estimate fat-free mass and its changes over time are needed. Objective The purpose of this study was to assess agreement among values obtained with three different body composition techniques: skinfold thickness measurement (STM), bioelectrical impedance analysis (BIA), and dual-energy x-ray absorptiometry (DXA). Design The study was a secondary analysis of data from a randomized controlled trial. Participants/setting A respiratory rehabilitation program was administered for 3 months to individuals with bronchiectasis from the bronchiectasis unit of the Regional University Hospital in Malaga, Spain, from September 2013 to September 2014. Individuals with a body mass index (calculated as kg/m2) >18.5 who were aged 65 years or younger and those with a body mass index >20 who were older than 65 years were included. Main outcome measures At baseline and at 3 and 6 months, body composition was determined by DXA and STM. Statistical analyses performed Statistical concordance was assessed with the intraclass correlation coefficient (ICC), kappa coefficient, and the degree of agreement using the Bland Altman method. For comparison of the quantitative variables at baseline vs at 3 months and 6 months, the paired sample t test (or the Wilcoxon test) was used. Results Thirty participants were included. Strong agreement was observed between body composition values determined by BIA and DXA in fat mass (ICC: 0.92) and fat-free mass (ICC: 0.87). Strong agreement was observed between STM and DXA in the values for fat-free mass (ICC: 0.91) and fat mass (ICC: 0.94), and lower agreement was observed for the longitudinal data and in the regional values. The mean difference between fat-free mass determined by BIA and DXA was + 4.7 with a standard deviation of 2.4 kg in favor of BIA. The mean difference between fat-free mass determined by STM and DXA was +2.3 with a standard deviation of 2.7 kg in favor of STM. Six individuals were classified as having a low fat-free mass index (20%) by DXA vs four by STM (13%; kappa: 0.76) and only two by BIA (6.6%; kappa: 0.44) compared with DXA. Conclusions Despite good statistical agreement among values obtained with DXA, STM, and BIA, the study findings indicate that STM and BIA, above all, tended to overestimate fat-free mass compared with DXA.
A Higher-Calorie Refeeding Protocol Does Not Increase Adverse Outcomes in Adult Patients with Eating Disorders J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-04-12 Kylie Matthews, Jan Hill, Shane Jeffrey, Susan Patterson, Amanda Davis, Warren Ward, Michelle Palmer, Sandra Capra
Background Patients with eating disorders (EDs) are often considered a high-risk population to refeed. Current research advises using “start low, go slow” refeeding methods (∼1,000 kcal/day, advancing ∼500 kcal/day every 3 to 4 days) in adult patients with severe EDs to prevent the development of refeeding syndrome (RFS), typically characterized by decreases in serum electrolyte levels and fluid shifts. Objective To compare the incidence of RFS and related outcomes using a low-calorie protocol (LC) (1,000 kcal) or a higher-calorie protocol (HC) (1,500 kcal) in medically compromised adult patients with EDs. Design This was a retrospective pre-test–post-test study. Participants/setting One hundred and nineteen participants with EDs, medically admitted to a tertiary hospital in Brisbane, Australia, between December 2010 and January 2017, were included (LC: n=26, HC: n=93). The HC refeeding protocol was implemented in September 2013. Main outcome measures Differences in prevalence of electrolyte disturbances, hypoglycemia, edema, and RFS diagnoses were examined. Statistical analysis performed χ2 tests, Kruskal-Wallis H test, analysis of variance, and independent t tests were used to compare data between the two protocols. Results Descriptors were similar between groups (LC: 28±9 years, 96% female, 85% with anorexia nervosa, 31% admitted primarily because of clinical symptoms of exacerbated ED vs HC: 27±9 years, 97% female, 84% with anorexia nervosa, 44% admitted primarily because of clinical symptoms of exacerbated ED, P>0.05). Participants refed using the LC protocol had higher incidence rates of hypoglycemia (LC: 31% vs HC: 10%, P=0.012), with no statistical or clinical differences in electrolyte disturbances (LC: 65% vs HC: 45%, P=0.079), edema (LC: 8% vs HC: 6%, P=0.722) or diagnosed RFS (LC: 4% vs HC: 1%, P=0.391). Conclusions A higher-calorie refeeding protocol appears to be safe, with no differences in rates of electrolyte disturbances or clinically diagnosed RFS and a lower incidence of hypoglycemia. Future research examining higher-calorie intakes, similar to those studied in adolescent patients, may be beneficial.
Reliability and Validity of Digital Imagery Methodology for Measuring Starting Portions and Plate Waste from School Salad Bars J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-04-12 Melanie K. Bean, Hollie A. Raynor, Laura M. Thornton, Alexandra Sova, Mary Dunne Stewart, Suzanne E. Mazzeo
Background Scientifically sound methods for investigating dietary consumption patterns from self-serve salad bars are needed to inform school policies and programs. Objective To examine the reliability and validity of digital imagery for determining starting portions and plate waste of self-serve salad bar vegetables (which have variable starting portions) compared with manual weights. Design/methods In a laboratory setting, 30 mock salads with 73 vegetables were made, and consumption was simulated. Each component (initial and removed portion) was weighed; photographs of weighed reference portions and pre- and post-consumption mock salads were taken. Seven trained independent raters visually assessed images to estimate starting portions to the nearest ¼ cup and percentage consumed in 20% increments. These values were converted to grams for comparison with weighed values. Statistical analyses Intraclass correlations between weighed and digital imagery–assessed portions and plate waste were used to assess interrater reliability and validity. Pearson’s correlations between weights and digital imagery assessments were also examined. Paired samples t tests were used to evaluate mean differences (in grams) between digital imagery–assessed portions and measured weights. Results Interrater reliabilities were excellent for starting portions and plate waste with digital imagery. For accuracy, intraclass correlations were moderate, with lower accuracy for determining starting portions of leafy greens compared with other vegetables. However, accuracy of digital imagery–assessed plate waste was excellent. Digital imagery assessments were not significantly different from measured weights for estimating overall vegetable starting portions or waste; however, digital imagery assessments slightly underestimated starting portions (by 3.5 g) and waste (by 2.1 g) of leafy greens. Conclusions This investigation provides preliminary support for use of digital imagery in estimating starting portions and plate waste from school salad bars. Results might inform methods used in empirical investigations of dietary intake in schools with self-serve salad bars.
The Mindful Eating Behavior Scale: Development and Psychometric Properties in a Sample of Dutch Adults Aged 55 Years and Older J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-04-11 Laura H.H. Winkens, Tatjana van Strien, Juan Ramón Barrada, Ingeborg A. Brouwer, Brenda W.J.H. Penninx, Marjolein Visser
Background Earlier scales on mindful eating do not measure mindful eating independent from emotional or external eating, or mindful eating in common situations. Objective The objective was to develop a new instrument to measure the attention element of mindful eating, the Mindful Eating Behavior Scale (MEBS), and to compute the internal structure, reliabilities, and convergent validity of this scale. Design A cross-sectional ancillary study within the Longitudinal Aging Study Amsterdam was conducted between fall 2014 and spring 2015. Participants/setting Participants were 1,227 Dutch adults aged 55 years and older from the Longitudinal Aging Study Amsterdam. Main outcome measure A selection of 20 items from existing instruments was used to design an initial version of the MEBS. Statistical analyses performed The internal structure of the MEBS was evaluated using an exploratory structural equation modeling approach on half of the sample and confirmatory factor analysis on the whole sample to develop the final version of the scale. The measurement invariance of the scores was tested with respect to sex, age, and body mass index. Reliabilities of subscales were determined with Cronbach’s α. To test convergent validity, the scores of the new scale were correlated with theoretically relevant variables. Results Two items were deleted because of low item loadings and one item because of high correlated uniqueness. The final confirmatory factor analysis model with 17 items and four domains (Focused Eating, Hunger and Satiety Cues, Eating with Awareness, and Eating without Distraction) showed good fit (comparative fit index=0.97, Tucker-Lewis index=0.96, and root mean square error of approximation=0.04). Measurement invariance was found for sex, age, and body mass index. Cronbach’s α values were medium to high (.70 to .89). Most correlations were in the expected directions, which indicated good preliminary convergent validity. Conclusions The MEBS was successfully developed consisting of 17 items and four domains. Because of low interfactor correlations, a total score combining the four domains should not be computed. The MEBS showed good internal consistency and preliminary convergent validity in a sample of Dutch adults aged 55 years and older.
Examining the Feasibility of Healthy Minimum Stocking Standards for Small Food Stores J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-04-09 Allison Karpyn, Robin S. DeWeese, Jennifer E. Pelletier, Melissa N. Laska, Punam Ohri-Vachaspati, Amy Deahl-Greenlaw, Ogheneruona Ughwanogho, Stephanie Bell Jilcott Pitts
Objective In response to recent national efforts to increase the availability of healthy food in small stores, we sought to understand the extent to which small food stores could implement the newly published Healthy Small Store Minimum Stocking Recommendations and reflect on the new US Department of Agriculture Food and Nutrition Service's final rule for stocking of staple foods for Supplemental Nutrition Assistance Program–approved retailers. Design We collected qualitative and quantitative data from 57 small stores in four states (Arizona, Delaware, Minnesota, and North Carolina) that accepted Supplemental Nutrition Assistance Program but not Special Supplemental Nutrition Assistance Program for Women, Infants, and Children benefits. Data from semistructured, in-depth interviews with managers/owners were transcribed, coded, and analyzed. We collected quantitative store inventory data onsite and later performed descriptive analyses. Results Store interviews revealed a reluctant willingness to stock healthy food and meet new recommendations. No stores met recommended fruit and vegetable stocking, although 79% carried at least one qualifying fruit and 74% carried at least one qualifying vegetable. Few stores met requirements for other food categories (ie, whole grains and low-fat dairy) with the exception of lean proteins, where stores carrying nuts or nut butter were more likely to meet the protein recommendation. Water and 100% juice were widely available and 68% met basic healthy beverage criteria. Conclusions In contrast to the inventory observed, most owners believed store stock met basic recommendations. Further, findings indicate that small stores are capable of stocking healthy products; however, technical and infrastructure support, as well as incentives, would facilitate shifts from staple to healthier staple foods. Retailers may need support to understand healthier product criteria and to drive consumer demand for new products.
Consistency and Generalizability of Dietary Patterns in a Multiethnic Working Population J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-04-01 Jui-Yee Eng, Foong-Ming Moy, Awang Bulgiba, Sanjay Rampal
Background Dietary pattern analysis is a complementary method to nutrient analysis in evaluating overall diet–disease hypotheses. Although studies have been conducted to derive dietary patterns among Malaysians, their consistency across subgroups has not been examined. Objective The study aimed to derive dietary patterns empirically and to examine the consistency and generalizability of patterns across sex, ethnicity, and urban status in a working population. Design This was a cross-sectional study using data from the Clustering of Lifestyle Risk Factors and Understanding its Association with Stress on Health and Well-Being among School Teachers in Malaysia study collected between August 2014 and November 2015. Dietary intake was assessed using a food frequency questionnaire, and dietary patterns were derived using factor analysis. Participants/setting Participants were teachers from selected public schools from three states in Peninsular Malaysia (n=4,618). Main outcome measures Dietary patterns derived using factor analysis. Statistical analyses performed Separate factor analysis was conducted by sex, ethnicity, and urban status to identify dietary patterns. Eigenvalue >2, scree plot, Velicer’s minimum average partial analysis, and Horn’s parallel analysis were used to determine the number of factors to retain. The interpretability of each dietary pattern was evaluated. The consistency and generalizability of dietary patterns across subgroups were assessed using the Tucker congruence coefficient. Results There was no subgroup-specific dietary pattern found. Thus, dietary patterns were derived using the pooled sample in the final model. Two dietary patterns (Western and Prudent) were derived. The Western dietary pattern explained 15.4% of total variance, characterized by high intakes of refined grains, animal-based foods, added fat, and sugar-sweetened beverages as well as fast food. The Prudent dietary pattern explained 11.1% of total variance and was loaded with pulses, legumes, vegetables, and fruits. Conclusions The derived Western and Prudent dietary patterns were consistent and generalizable across subgroups of sex, ethnicity, and urban status. Further research is needed to explore associations between these dietary patterns and chronic diseases.
2015 Evidence Analysis Library Systematic Review on Advanced Technology in Food Production J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-03-08 Marianne Smith Edge, Mary Elizabeth Kunkel, Jennifer Schmidt, Constantina Papoutsakis
In the late 20th century, plant breeders began using molecular biology techniques such as recombinant DNA, also known as genetic engineering, along with traditional cross-breeding. Ten plant and one animal food have been approved for commercialization in the United States. Today, foods and ingredients from genetically engineered (GE) crops are present throughout the food supply, which has led to varying levels of acceptance. Much discussion exists among consumers and health professionals about the believability of statements made regarding benefits or risks of GE foods. The aim of this systematic review was to examine the evidence on the association of consumption of GE foods and ingredients derived from them on human health, specifically allergenicity, food safety, pesticide consumption, nutrient adequacy, inflammation, and antibiotic resistance. An expert panel conducted a systematic review on advanced technology in food production. The 30 developed questions focused on effects of human consumption of GE foods and the effects of human consumption of foods containing pesticide residues on human health. Primary research published from 1994 to 2014 were identified using PubMed and Agricultural Online Access databases. Additional studies were identified by searching references of review articles. Twenty-one studies met the inclusion criteria. Relevant research addressed five of 30 questions. Four questions focused on food allergenicity, the fifth on nutrient adequacy, and all received a Grade III (limited/weak) rating. No human studies addressed 25 questions on the consumption of foods produced using genetic engineering technologies on gene translocation, cancer, food safety, phenotype expression, inflammation and inflammatory markers, or antibiotic resistance. These questions received a Grade V (grade not assignable). Evidence from human studies did not reveal an association between adverse health effects and consumption of foods produced using genetic engineering technologies. Although the number of available human studies is small, they support that there are no clear adverse health effects—as they relate to allergenicity and nutrient adequacy—associated with consumption of GE foods. The present systematic review is aligned with a recent report by the National Academy of Sciences that included human and animal research.
Nutrition and Bone Density in Boys with Autism Spectrum Disorder J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-03-02 Ann M. Neumeyer, Natalia Cano Sokoloff, Erin I. McDonnell, Eric A. Macklin, Christopher J. McDougle, Tara M. Holmes, Jane L. Hubbard, Madhusmita Misra
Background Boys with autism spectrum disorder (ASD) have lower bone mineral density (BMD) than typically developing controls. Differences in diet and exercise may contribute to low BMD. Objective Our aim was to examine macro- and micronutrient intakes and self-reported physical activity in boys with ASD compared to TDC and the relationship of these variables with BMD. Design/methods We conducted a cross-sectional study of 49 boys (25 ASD, 24 typically developing controls) assessed for 3-day food records and physical activity records, and BMD of the whole body less head, hip, and spine using dual-energy x-ray absorptiometry. Fasting levels of 25(OH) vitamin D and calcium were obtained. Participants Participants were adolescent boys, aged 8 to 17 years, recruited from a clinic population (ASD) or community advertisements (ASD and typically developing controls) matched for age. Results ASD participants were approximately 9 months younger than typically developing control participants on average. Body mass index and serum vitamin D and calcium levels were similar. Boys with ASD consumed 16% fewer calories, with a larger percentage obtained from carbohydrates, and 37% less animal protein and 20% less fat than typically developing controls. A lower proportion of ASD participants were categorized as “very physically active” (27% vs 79%; P<0.001). BMD z scores were 0.7 to 1.2 standard deviations lower in ASD than typically developing controls at all locations. Higher animal protein, calcium, and phosphorus intakes were associated positively with bone density measures in boys with ASD. Conclusions Compared to typically developing controls, boys with ASD had lower protein, calcium, and phosphorus intakes, activity levels, and BMD z scores at the lumbar spine, femoral neck, total hip, and whole body less head. Protein, calcium, and phosphorus intakes were associated positively with BMD.
Evaluating Photographs as a Replacement for the In-Person Physical Examination of the Scored Patient-Generated Subjective Global Assessment in Elderly Hospital Patients J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-02-21 Michelle Miller, Jolene Thomas, Jenni Suen, De Sheng Ong, Yogesh Sharma
Background Undernourished patients discharged from the hospital require follow-up; however, attendance at return visits is low. Teleconsultations may allow remote follow-up of undernourished patients; however, no valid method to remotely perform physical examination, a critical component of assessing nutritional status, exists. Objective This study aims to compare agreement between photographs taken by trained dietitians and in-person physical examinations conducted by trained dietitians to rate the overall physical examination section of the scored Patient Generated Subjective Global Assessment (PG-SGA). Design Nested cross-sectional study. Participants/setting Adults aged ≥60 years, admitted to the general medicine unit at Flinders Medical Centre between March 2015 and March 2016, were eligible. All components of the PG-SGA and photographs of muscle and fat sites were collected from 192 participants either in the hospital or at their place of residence after discharge. Main outcome measures Validity of photograph-based physical examination was determined by collecting photographic and PG-SGA data from each participant at one encounter by trained dietitians. A dietitian blinded to data collection later assessed de-identified photographs on a computer. Statistical analyses performed Percentage agreement, weighted kappa agreement, sensitivity, and specificity between the photographs and in-person physical examinations were calculated. All data collected were included in the analysis. Results Overall, the photograph-based physical examination rating achieved a percentage agreement of 75.8% against the in-person assessment, with a weighted kappa agreement of 0.526 (95% CI: 0.416, 0.637; P<0.05) and a sensitivity-specificity pair of 66.9% (95% CI: 57.8%, 75.0%) and 92.4% (95% CI: 82.5%, 97.2%). Conclusions Photograph-based physical examination by trained dietitians achieved a nearly acceptable percentage agreement, moderate weighted kappa, and fair sensitivity-specificity pair. Methodological refinement before field testing with other personnel may improve the agreement and accuracy of photograph-based physical examination.
Reliability of Patient-Led Screening with the Malnutrition Screening Tool: Agreement between Patient and Health Care Professional Scores in the Cancer Care Ambulatory Setting J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-02-15 Alexandra Di Bella, Claire Blake, Adrienne Young, Anita Pelecanos, Teresa Brown
Background The prevalence of malnutrition in patients with cancer is reported as high as 60% to 80%, and malnutrition is associated with lower survival, reduced response to treatment, and poorer functional status. The Malnutrition Screening Tool (MST) is a validated tool when administered by health care professionals; however, it has not been evaluated for patient-led screening. Objectives This study aims to assess the reliability of patient-led MST screening through assessment of inter-rater reliability between patient-led and dietitian-researcher–led screening and intra-rater reliability between an initial and a repeat patient screening. Design/participants This cross-sectional study included 208 adults attending ambulatory cancer care services in a metropolitan teaching hospital in Queensland, Australia, in October 2016 (n=160 inter-rater reliability; n=48 intra-rater reliability measured in a separate sample). Main outcome measurements Primary outcome measures were MST risk categories (MST 0-1: not at risk, MST ≥2: at risk) as determined by screening completed by patients and a dietitian-researcher, patient test–retest screening, and patient acceptability. Statistical analysis Percent and chance-corrected agreement (Cohen’s kappa coefficient, κ) were used to determine agreement between patient-MST and dietitian-MST (inter-rater reliability) and MST completed by patient on admission to unit (patient-MSTA) and MST completed by patient 1 to 3 hours after completion of initial MST (patient-MSTB) (intra-rater reliability). Results High inter-rater reliability and intra-rater reliability were observed. Agreement between patient-MST and dietitian-MST was 96%, with “almost perfect” chance-adjusted agreement (κ=0.92, 95% CI 0.84 to 0.97). Agreement between repeated patient-MSTA and patient-MSTB was 94%, with “almost perfect” chance-adjusted agreement (κ=0.88, 95% CI 0.71 to 1.00). Based on dietitian-MST, 33% (n=53) of patients were identified as being at risk for malnutrition, and 40% of these reported not seeing a dietitian. Of 156 patients who provided feedback, almost all reported that the MST was clear (92%), questions were easy to understand (95%), and completion time was ≤5 minutes (99%). Conclusion Patient-led screening with the MST is reliable and well accepted by patients. Patient-led screening in the cancer care ambulatory setting has the potential to improve patient autonomy and screening completion rates.
Turning the Waiting Room into a Classroom: Weekly Classes Using a Vegan or a Portion-Controlled Eating Plan Improve Diabetes Control in a Randomized Translational Study J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-02-15 Neal D. Barnard, Susan M. Levin, Lise Gloede, Rosendo Flores
Background In research settings, plant-based (vegan) eating plans improve diabetes management, typically reducing weight, glycemia, and low-density lipoprotein (LDL) cholesterol concentrations to a greater extent than has been shown with portion-controlled eating plans. Objective The study aimed to test whether similar benefits could be found using weekly nutrition classes in a typical endocrinology practice, hypothesizing that a vegan eating plan would improve glycemic control, weight, lipid concentrations, blood pressure, and renal function and would do so more effectively than a portion-controlled eating plan. Design In a 20-week trial, participants were randomly assigned to a low-fat vegan or portion-controlled eating plan. Participants/setting Individuals with type 2 diabetes treated in a single endocrinology practice in Washington, DC, participated (45 starters, 40 completers). Intervention Participants attended weekly after-hours classes in the office waiting room. The vegan plan excluded animal products and added oils and favored low-glycemic index foods. The portion-controlled plan included energy intake limits for weight loss (typically a deficit of 500 calories/day) and provided guidance on portion sizes. Main outcome measures Body weight, hemoglobin A1c (HbA1c), plasma lipids, urinary albumin, and blood pressure were measured. Statistical analyses performed For normally distributed data, t tests were used; for skewed outcomes, rank-based approaches were implemented (Wilcoxon signed-rank test for within-group changes, Wilcoxon two-sample test for between-group comparisons, and exact Hodges-Lehmann estimation to estimate effect sizes). Results Although participants were in generally good metabolic control at baseline, body weight, HbA1c, and LDL cholesterol improved significantly within each group, with no significant differences between the two eating plans (weight: −6.3 kg vegan, −4.4 kg portion-controlled, between-group P=0.10; HbA1c, −0.40 percentage point in both groups, P=0.68; LDL cholesterol −11.9 mg/dL vegan, −12.7 mg/dL portion-controlled, P=0.89). Mean urinary albumin was normal at baseline and did not meaningfully change. Blood pressure changes were not significant. Conclusions Weekly classes, integrated into a clinical practice and using either a low-fat vegan or portion-controlled eating plan, led to clinical improvements in individuals with type 2 diabetes.
Associations between Food Security Status and Dietary Inflammatory Potential within Lower-Income Adults from the United States National Health and Nutrition Examination Survey, Cycles 2007 to 2014 J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-02-13 Rachel S. Bergmans, Mari Palta, Stephanie A. Robert, Lawrence M. Berger, Deborah B. Ehrenthal, Kristen M. Malecki
Background Evidence suggests both that chronic inflammation mediates the association of food insecurity with adverse health outcomes and that diet may be a significant source of inflammation among food insecure individuals. Objective To examine whether food security status is associated with dietary inflammatory potential. Design and participants Cross-sectional data came from the National Health and Nutrition Examination Survey (NHANES), cycles 2007 to 2014 (n=10,630). The analysis sample is representative of noninstitutionalized US adults with an income-to-poverty ratio ≤3.00. Main outcome Dietary Inflammatory Index (DII) score, calculated using the average of two 24-hour dietary recalls, was the main outcome measure. Statistical analysis Type III F tests or χ2 tests compared population characteristics by food security status, defined using the US Food Security Survey Module. Multivariable linear regression was used to estimate the association between food security status and the DII score and moderation by demographic factors. Survey weighting procedures accounted for the effects of stratification and clustering used in the NHANES study design. Results When accounting for socioeconomic status, demographic factors, and health status, DII score was higher at greater levels of food insecurity (P=0.0033). Those with very low food security had a 0.31 (95% CI=0.12 to 0.49) higher DII score than those with high food security. Age moderated the association between food security status and DII score (interaction P=0.0103), where the magnitude of the association between DII score and severity of food insecurity was higher for those >65 years than for younger age groups. Conclusion Food security status may be associated with dietary inflammatory potential, which is hypothesized to play a role in multiple chronic health conditions. Further research is needed to determine the causal nature of this relationship and evaluate how best to implement programs designed to address health disparities within food insecure populations.
US Military Dietetic Internship and Graduate Program: Retrospective Analysis of Selection Criteria and Student Success J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-02-07 Heidi L. Clark, Renee E. Cole, LesLee K. Funderburk
Background The US Military-Baylor Graduate Program in Nutrition (GPN) has a 10% 7-year attrition rate representing wasted military resources. Evidence-based selection criteria for dietetics masters of science (MS) programs do not exist, nor does descriptive information of successful students. Objective Identify GPN student characteristics predicting program success in the didactic and internship phases. Design Retrospective study using demographic, academic, and nonacademic data extracted from existing files. Participants and setting There were 72 GPN students enrolled from 2006 to 2013 in San Antonio, TX. Main outcome measures Categorization by optimal performance (no course grade <3.0, no internship rotation delays, first attempt pass registered dietitian nutritionist examination) and GPN completion. Results The average GPN student was female (65%), in the US Army (94%), and single (64%), with a mean age of 26 years. Mean Quantitative, Verbal Reasoning, and Analytical Writing Graduate Record Examination (GRE) scores were 149, 153, and 4.2 points, respectively. Odds of GPN failure increased 1.3 times with each year increase in age at GPN program start (95% CI=1.089 to 1.612; P=0.005). Odds of attaining optimal performance decreased 4.5 times with each additional year increase between GRE completion and GPN start (95% CI=1.623 to 16.236; P=0.005) and 0.157 times with each grade point average point decrease in Biochemistry (95% CI=0.49 to 0.430; P=0.002). Conclusions Modification of selection criteria based on time between GRE and GPN start and undergraduate Biochemistry grades could improve GPN success. However, identification and mitigation of potential student weaknesses is a more realistic approach to promote student success. Intentional development of students with optimal characteristics will strengthen the dietetics profession during the transition to an MS degree requirement.
Accessibility Landscapes of Supplemental Nutrition Assistance Program−Authorized Stores J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-02-01 Elizabeth F. Racine, Eric Delmelle, Elizabeth Major, Corliss A. Solomon
Background The Supplemental Nutrition Assistance Program (SNAP) is the largest food assistance program in the United States. Participants receive electronic benefits that are redeemable at a variety of food stores. Previous research notes that low-income neighborhoods often lack supermarkets with high-quality, affordable food. Objective The first aim of this study was to explore the number and spatial distribution of SNAP stores by type and to assess how SNAP benefit redemption is linked to store type in North Carolina in 2015. The second aim was to compare the demographics of populations living in areas with a high concentration of SNAP participants vs areas with a lower concentration of SNAP participants. The third aim was to test for disparities in the availability of and access to SNAP-authorized stores in areas with high vs low concentration of SNAP participants stratified by rural/urban status. Design US Department of Agriculture and US Census data were used to explore the spatial distribution of SNAP stores at the census block group level utilizing a Geographic Information System. Participants The 9,556 North Carolina SNAP stores in 2015 categorized into full-variety and limited-variety stores. Outcome measures Proximity to limited-variety SNAP food stores and full-variety SNAP food stores within access range (1 mile in urban areas and 10 miles in rural areas). Statistical analyses Wilcoxon rank sum and χ2 tests are used to compare the distance to and concentration of SNAP stores by rurality and SNAP participant concentration at census block group scale. Results Among the SNAP stores in North Carolina, 83% are limited-variety stores and 17% are full-variety stores. There are disparities in the demographics of individuals living in census block groups with a high proportion of SNAP participants compared to census block groups with a lower proportion of SNAP participants. More households in higher SNAP participant census block groups were non-white, did not have a car, and had children compared to census block groups with lower SNAP participation. Residents in high SNAP participant census block groups typically had access to 0 full-variety stores and 4 limited-variety stores in urban areas and 3 full-variety stores and 17 limited-variety stores in rural areas. Conclusions SNAP participant access to a variety of stores should be considered when approving food stores for SNAP authorization. More research is essential to disentangle the relationship between access to SNAP store type and SNAP food choice and to estimate geographical disparities.
Association of Individual and Neighborhood Factors with Home Food Availability: Evidence from the National Health and Nutrition Examination Survey J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-02-01 Weiwen Chai, Jessie X. Fan, Ming Wen
Background Accumulating evidence suggests the important role of the home food environment in an individual’s dietary intake. Objective This study examined the associations of individual and neighborhood-level factors with the availability of healthy and unhealthy foods in the home using a nationally representative sample from the 2007 to 2008 and 2009 to 2010 National Health and Nutrition Examination Surveys (NHANES). Design A cross-sectional study design was used with NHANES merged with the 2000 census data. Food availability was measured through self-report questionnaire regarding the frequency of foods or drinks available in the home. Participants The analysis included 8,975 participants aged 19 to 65 years. Statistical analyses performed Associations of individual and neighborhood factors with home food availability (always or most of the time available) were assessed using logistic regression modeling accounting for NHANES’ complex survey design and weights. Individual-level and neighborhood-level factors were simultaneously included in the analysis. Results Family income-to-needs ratio was positively associated with the availability of dark green vegetables (odds ratio [OR]=1.07; 95% CI=1.00 to 1.13), fat-free or low-fat milk (OR=1.16; 95% CI=1.07 to 1.25), and salty snacks (OR=1.12; 95% CI=1.04 to 1.20) in the home. College graduates were more likely to have fruits (OR=1.96, 95% CI=1.48 to 2.60), vegetables (OR=1.48; 95% CI=1.16 to 1.88), and fat-free or low-fat milk (OR=1.81; 95% CI=1.55 to 2.12) and less likely to have salty snacks (OR=0.77; 95% CI=0.63 to 0.95) and sugary drinks (OR=0.46, 95% CI=0.37 to 0.57) available compared with non-college graduates. Tract socioeconomic status (SES) scores were positively associated with fruit (OR=1.15; 95% CI=1.02 to 1.29), vegetable (OR=1.14; 95% CI=1.03 to 1.26), and fat-free or low-fat milk (OR=1.25; 95% CI=1.10 to 1.42) availability. Urban residents were associated with greater availability of fruits (OR=1.47; 95% CI=1.05 to 2.08) and fat-free or low-fat milk (OR=1.33; 95% CI=1.02 to 1.73) in the home compared with rural residents. Food desert status was not associated with home food availability. Conclusions The results show that SES at both individual (education, income) and neighborhood level was linked to home food availability, suggesting a need to improve the home food environment for socioeconomically disadvantaged individuals and neighborhoods.
Added Sugar Intake among Pregnant Women in the United States: National Health and Nutrition Examination Survey 2003-2012 J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-01-09 Catherine E. Cioffi, Janet Figueroa, Jean A. Welsh
Background Despite associations of dietary added sugar with excess weight gain and chronic disease risk, intake among most Americans exceeds the recommended limits (<10% total energy). Maternal diet plays an important role in pregnancy-related outcomes, but little is known about the extent of added sugar intake during pregnancy. Objective To assess intake and identify the top sources of added sugars in the diets of pregnant vs nonpregnant women in the United States. Design Cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES), 2003-2004 to 2011-2012. Participants Four thousand one hundred seventy-nine pregnant and nonpregnant women (aged 20 to 39 years) who completed a dietary recall. Statistical analyses performed Survey-weighted analyses were used to estimate means (95% CIs) in total grams and as percentage of total energy for added sugar intake by pregnancy status and by demographic subgroup and to identify leading sources of added sugar. Results Added sugar intake trended toward being higher in pregnant compared with nonpregnant women in absolute grams, 85.1 g (95% CI: 77.4 to 92.7) vs 76.7 g (95% CI: 73.6 to 79.9), respectively (P=0.06), but was lower among pregnant women when total energy intake was accounted for, 14.8% (95% CI: 13.8 to 15.7) vs 15.9% (95% CI: 15.2 to 16.6) of total energy, respectively (P=0.03). Among pregnant women, added sugar intake was similar among demographic subgroups. However, in multivariable regression, pregnancy status significantly modified the associations of education and income with added sugar intake, whereby less educated and lower-income women who were pregnant had lower added sugar intakes compared with those who were not pregnant, but more educated or higher-income women did not exhibit this pattern. The top five sources of added sugar for all women were sugar-sweetened beverages; cakes, cookies, and pastries; sugars and sweets; juice drinks and smoothies; and milk-based desserts. Conclusions Although pregnant women had higher energy intakes, this was not attributed to higher intakes of added sugar. Although education and income affected consumption during pregnancy, intake of added sugar among all women, regardless of pregnancy status, exceeded recommendations.
Calorie Labels on the Restaurant Menu: Is the Use of Weight-Control Behaviors Related to Ordering Decisions? J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-01-08 Nicole Larson, Ann F. Haynos, Christina A. Roberto, Katie A. Loth, Dianne Neumark-Sztainer
Background There is emerging evidence that calorie information on restaurant menus does not similarly influence the ordering decisions of all population groups and may have unintended consequences for individuals who struggle with disordered eating or other weight-related concerns. Objective This study describes demographic patterns in the use of calorie information on restaurant menus and investigates relationships between using this information to limit calorie intake and measures of restaurant visit frequency and weight-related concerns and behavior. Design/participants There were 788 men and 1042 women (mean age=31.0±1.6 years) who participated in the fourth wave of the Project EAT study. Participants were initially recruited from Minneapolis-St Paul, MN, schools and completed EAT-IV surveys online or by mail from 2015 to 2016. Main outcome measures Participants self-reported weight-related concerns, restaurant eating, intuitive eating, dieting, healthy (eg, exercise) and unhealthy (eg, use of laxatives) weight-control behaviors, and binge eating. Statistical analyses performed Descriptive statistics and linear and logistic regression models accounting for demographics and weight status. Results Approximately half of participants (52.7%) reported they had noticed calorie information while purchasing a meal or snack in a restaurant within the previous month. Among individuals who noticed calorie information, 38.2% reported they did not use it in deciding what to order. The most common use of calorie information was to avoid high-calorie menu items (50.1%) or to decide on a smaller portion (20.2%). Using menu labels to limit calories was related to binge eating among women and was associated with more weight-related concerns, dieting, and unhealthy weight-control behaviors among both women and men. Conclusions Nutrition educators and other health care professionals should talk with clients who struggle with disordered eating or weight-related concerns to learn about their use of calorie information at restaurants, address any potential unintended consequences, and promote healthy uses of calorie information.
Changes in Energy Intake and Diet Quality during an 18-Month Weight-Management Randomized Controlled Trial in Adults with Intellectual and Developmental Disabilities J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-01-06 Lauren T. Ptomey, Felicia L. Steger, Jaehoon Lee, Debra K. Sullivan, Jeannine R. Goetz, Jeffery J. Honas, Richard A. Washburn, Cheryl A. Gibson, Joseph E. Donnelly
Background Previous research indicates that individuals with intellectual and developmental disabilities (IDDs) are at risk for poor diet quality. Objective The purpose of this secondary analysis was to determine whether two different weight-loss diets affect energy intake, macronutrient intake, and diet quality as measured by the Healthy Eating Index-2010 (HEI-2010) during a 6-month weight-loss period and 12-month weight-management period, and to examine differences in energy intake, macronutrient intake, and HEI-2010 between groups. Design Overweight/obese adults with IDDs took part in an 18-month randomized controlled trial and were assigned to either an enhanced Stop Light Diet utilizing portion-controlled meals or a conventional diet consisting of reducing energy intake and following the 2010 Dietary Guidelines for Americans. Proxy-assisted 3-day food records were collected at baseline, 6 months, and 18 months, and were analyzed using Nutrition Data System for Research software. HEI-2010 was calculated using the data from Nutrition Data System for Research. Participants/setting The study took place from June 2011 through May 2014 in the greater Kansas City metropolitan area. Main outcome measures This was a secondary analysis of a weight-management intervention for adults with IDDs randomized to an enhanced Stop Light Diet or conventional diet, to examine differences in energy intake, macronutrient intake, and HEI-2010 across time and between groups. Statistical analyses performed Independent- and paired-samples t tests and general mixed modeling for repeated measures were performed to examine group differences and changes at baseline, 6 months, and 18 months between the enhanced Stop Light Diet and conventional diet groups. Results One hundred and forty six participants (57% female, mean±standard deviation age=36.2±12.0 years) were randomized to either the enhanced Stop Light Diet or conventional diet group (77 enhanced Stop Light Diet, 69 conventional diet) and provided data for analysis at baseline, 124 completed the 6-month weight-loss period, and 101 completed the 18-month study. Participants on the enhanced Stop Light Diet diet significantly reduced energy intake at 6 and 18 months (both P<0.001), but those on the conventional diet did not (both P=0.13). However, when accounting for age, sex, race, education level, and support level (mild vs moderate IDD), there was a significant decrease during the 18-month intervention in energy intake for the enhanced Stop Light Diet and conventional diet groups combined (P<0.01 for time effect), but no significant group difference in this change (P=0.39 for group-by-time interaction). There was no significant change in total HEI-2010 score at 6 and 18 months (P=0.05 and P=0.38 for the enhanced Stop Light Diet group; P=0.22 and P=0.17 for the conventional diet group), and no significant group difference at 6 and 18 months (P=0.08 and P=0.42). However, when participants’ age, sex, race, education level, and support level were accounted for, mixed modeling indicated a significant increase in total HEI-2010 scores for the enhanced Stop Light Diet and conventional diet groups combined during the 18-month intervention (P=0.01 for time effect). Conclusions The results of this study found that after controlling for demographic factors, individuals with IDDs can decrease their energy intake and increase their diet quality, with no significant differences between the enhanced Stop Light Diet and conventional diet groups.
Sodium-Reduced Meat and Poultry Products Contain a Significant Amount of Potassium from Food Additives J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-01-06 Arti Sharma Parpia, Marc B. Goldstein, JoAnne Arcand, France Cho, Mary R. L’Abbé, Pauline B. Darling
Background Sodium-reduced packaged food products are increasingly available to consumers; however, it is not clear whether they are suitable for inclusion in a potassium-reduced diet. For individuals with impaired renal potassium excretion caused by chronic kidney disease and for those taking certain medications that interfere with the rennin-angiotensin aldosterone axis, the need to limit dietary potassium is important in view of the risk for development of hyperkalemia and fatal cardiac arrhythmias. Objective The primary objective of this study was to determine the impact of the reduction of sodium in packaged meat and poultry products (MPPs) on the content of potassium and phosphorus from food additives. Design This was a cross-sectional study comparing chemically analyzed MPPs (n=38, n=19 original, n=19 sodium-reduced), selected from the top three grocery chains in Canada, based on market share sales. All MPPs with a package label containing a reduced sodium content claim together with their non-sodium-reduced packaged MPP counterparts were selected for analysis. The protein, sodium, phosphorus, and potassium contents of sodium-reduced MPPs and the non-sodium-reduced (original) MPP counterparts were chemically analyzed according to the Association of Analytical Communities official methods 992.15 and 984.27 and compared by using a paired t test. The frequency of phosphorus and potassium additives appearing on the product labels' ingredient lists were compared between groups by using McNemar’s test. Results Sodium-reduced MPPs (n=19) contained 44% more potassium (mg/100 g) than their non-sodium-reduced counterparts (n=19) (mean difference [95% CI): 184 [90-279]; P=0.001). The potassium content of sodium-reduced MPPs varied widely and ranged from 210 to 1,500 mg/100 g. Potassium-containing additives were found on the ingredient list in 63% of the sodium-reduced products and 26% of the non–sodium-reduced products (P=0.02). Sodium-reduced MPPs contained 38% less sodium (mg/100 g) than their non–sodium-reduced counterparts (mean difference [95% CI]: 486 [334-638]; P<0.001). The amounts of phosphorus and protein, as well as the frequency of phosphorus additives appearing on the product label ingredient list, did not significantly differ between the two groups. Conclusions Potassium additives are frequently added to sodium-reduced MPPs in amounts that significantly contribute to the potassium load for patients with impaired renal handling of potassium caused by chronic kidney disease and certain medications. Patients requiring potassium restriction should be counseled to be cautious regarding the potassium content of sodium-reduced MPPs and encouraged to make food choices accordingly.
Relationships among Dietary Intakes and Persistent Gastrointestinal Symptoms in Patients Receiving Enzyme Treatment for Genetic Sucrase-Isomaltase Deficiency J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-01-06 Anne Boney, Heather E. Elser, Heidi J. Silver
Background Sucrose-isomaltase deficiency (SID) remains underdiagnosed. Absent or reduced enzyme activity promotes diarrhea, abdominal bloating, and flatulence from undigested and malabsorbed disaccharides. Frequency and severity of gastrointestinal symptoms may be associated with the type of carbohydrates consumed. Objective To characterize the dietary intakes of patients treated with sacrosidase (Sucraid; QOL Medical) for SID and determine relationships between type of carbohydrates, sacrosidase dose, and gastrointestinal symptoms. Design A prospective 30-day observational study. Participants/setting Forty-nine patients treated with sacrosidase for ≥3 months were recruited from the enzyme manufacturer’s nationwide clinical database between November 2014 and August 2015. Main outcome measures Dietary energy and nutrient intakes reported during 24-hour diet recall interviews, frequency and severity of gastrointestinal (GI) symptoms, and sacrosidase dose. Statistical analyses performed Relationships between nutrient intakes, sacrosidase dose, and GI symptoms were evaluated using Spearman ρ correlation coefficients. Results Sacrosidase dose averaged 5.2±3.1 mL/day. Participants reported 1.3±0.9 bowel movements daily. Having less frequent GI symptoms was associated with higher sacrosidase intake. Energy intakes averaged 1,562.5±411.5 kcal/day in children, 1,964.7±823.6 kcal/day in adolescents, and 1,952.6±546.5 kcal/day in adults. Macronutrient composition averaged 44% carbohydrate, 39% fat, and 17% protein. Average carbohydrate composition was 35% starch, 8% fiber, and 59% sugars. Sucrose and fructose intakes were not associated with GI symptoms. Lactose intake was associated with diarrhea. Maltose intake was associated with nausea, distension, and reflux. Conclusions Intakes were lower in carbohydrates and higher in fat compared with the Acceptable Macronutrient Distribution Ranges. Sucrose and fructose intakes were not associated with GI symptoms. Higher maltose and lactose intakes were associated with GI symptom frequency and severity. These findings provide evidence to guide nutrition counseling for patients treated for SID.
Timing of Introduction of Complementary Foods to US Infants, National Health and Nutrition Examination Survey 2009-2014 J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-01-04 Chloe M. Barrera, Heather C. Hamner, Cria G. Perrine, Kelley S. Scanlon
Background Although there has been inconsistency in recommendations regarding the optimal time for introducing complementary foods, most experts agree that introduction should not occur before 4 months. Despite recommendations, studies suggest that 20% to 40% of US infants are introduced to foods at younger than 4 months. Previous studies focused on the introduction of solid foods and are not nationally representative. Objective Our aims were to provide a nationally representative estimate of the timing of introduction of complementary foods and to describe predictors of early (<4 months) introduction. Design We conducted a cross-sectional analysis of 2009-2014 National Health and Nutrition Examination Survey data. Participants The study included 1,482 children aged 6 to 36 months. Main outcome measures Timing of first introduction to complementary foods (anything other than breast milk or formula) was analyzed. Statistical analyses performed Prevalence estimates of first introduction to complementary foods are presented by month. Logistic regression was used to assess characteristics associated with early (<4 months) introduction. Results In this sample, 16.3% of US infants were introduced to complementary foods at <4 months, 38.3% between 4 and <6 months, 32.5% between 6 and <7 months, and 12.9% at ≥7 months of age. In unadjusted analyses, early introduction varied by breastfeeding status; race/Hispanic origin; Special Supplemental Nutrition Program for Women, Infants, and Children participation; and maternal age. In adjusted analyses, only breastfeeding status remained significant; infants who never breastfed or stopped at <4 months were more likely (odds ratio 2.27; 95% CI 1.62 to 3.18) to be introduced to complementary foods early than infants who breastfed ≥4 months. Conclusions Despite using a broader definition of complementary foods, this analysis found a lower prevalence of early introduction in this nationally representative sample than previous studies that included only solids. However, many young children were still introduced to complementary foods earlier than recommended. Strategies to support caregivers to adhere to infant feeding guidelines may be needed.
Effects of the Ser326Cys Polymorphism in the DNA Repair OGG1 Gene on Cancer, Cardiovascular, and All-Cause Mortality in the PREDIMED Study: Modulation by Diet J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-01-02 Dolores Corella, Judith B. Ramírez-Sabio, Oscar Coltell, Carolina Ortega-Azorín, Ramón Estruch, Miguel A. Martínez-González, Jordi Salas-Salvadó, José V. Sorlí, Olga Castañer, Fernando Arós, Franscisco J. Garcia-Corte, Lluís Serra-Majem, Enrique Gómez-Gracia, Miquel Fiol, Xavier Pintó, Guillermo T. Saez, Estefanía Toledo, Josep Basora, Montserrat Fitó, Montserrat Cofán, Emilio Ros, Jose M. Ordovas
Background Oxidatively induced DNA damage, an important factor in cancer etiology, is repaired by oxyguanine glycosylase 1 (OGG1). The lower repair capacity genotype (homozygote Cys326Cys) in the OGG1-rs1052133 (Ser326Cys) polymorphism has been associated with cancer risk. However, no information is available in relation to cancer mortality, other causes of death, and modulation by diet. Objective Our aim was to evaluate the association of the OGG1-rs1052133 with total, cancer, and cardiovascular disease (CVD) mortality and to analyze its modulation by the Mediterranean diet, focusing especially on total vegetable intake as one of the main characteristics of this diet. Design Secondary analysis in the PREDIMED (Prevención con Dieta Mediterránea) trial is a randomized, controlled trial conducted in Spain from 2003 to 2010. Participants/setting Study participants (n=7,170) were at high risk for CVD and were aged 55 to 80 years. Intervention Participants were randomly allocated to two groups with a Mediterranean diet intervention or a control diet. Vegetable intake was measured at baseline. Main outcome measures Main outcomes were all-cause, cancer, and CVD mortality after a median follow-up of 4.8 years. Statistical analyses Multivariable-adjusted Cox regression models were fitted. Results Three hundred eighteen deaths were detected (cancer, n=127; CVD, n=81; and other, n=110). Cys326Cys individuals (prevalence 4.2%) presented higher total mortality rates than Ser326-carriers (P=0.009). The multivariable-adjusted hazard ratio for Cys326Cys vs Ser326-carriers was 1.69 (95% CI 1.09 to 2.62; P=0.018). This association was greater for CVD mortality (P=0.001). No relationship was detected for cancer mortality in the whole population (hazard ratio 1.07; 95% CI 0.47 to 2.45; P=0.867), but a significant age interaction (P=0.048) was observed, as Cys326Cys was associated with cancer mortality in participants <66.5 years (P=0.029). Recessive effects limited our ability to investigate Cys326Cys×diet interactions for cancer mortality. No statistically significant interactions for total or CVD mortality were found for the Mediterranean diet intervention. However, significant protective interactions for CVD mortality were found for vegetable intake (hazard ratio interaction per standard deviation 0.42; 95% CI 0.18 to 0.98; P=0.046). Conclusions In this population, the Cys326Cys-OGG1 genotype was associated with all-cause mortality, mainly CVD instead of cancer mortality. Additional studies are needed to provide further evidence on its dietary modulation.
Pilot Randomized Controlled Trial of a Home Vegetable Gardening Intervention among Older Cancer Survivors Shows Feasibility, Satisfaction, and Promise in Improving Vegetable and Fruit Consumption, Reassurance of Worth, and the Trajectory of Central Adiposity J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-01-02 Wendy Demark-Wahnefried, Mallory G. Cases, Alan B. Cantor, Andrew D. Frugé, Kerry P. Smith, Julie Locher, Harvey J. Cohen, Yuko Tsuruta, Michael Daniel, Rishabh Kala, Jennifer F. De Los Santos
Background Holistic approaches are sought to improve lifestyle behaviors and health of cancer survivors long term. Objective Our aim was to explore whether a home-based vegetable gardening intervention is feasible and whether it improves diet and other health-related outcomes among older cancer survivors. Design We conducted a feasibility trial in which cancer survivors were randomized to receive a year-long gardening intervention immediately or to a wait-list control arm. Home visits at baseline and 1 year assessed physical performance, anthropometric indices, behavioral and psychosocial outcomes, and biomarkers. Participants/setting Participants included 46 older (aged 60+ years) survivors of locoregionally staged cancers across Alabama from 2014 to 2016. Forty-two completed 1-year follow-up. Intervention Cooperative extension master gardeners delivered guidance to establish three seasonal vegetable gardens at survivors’ homes. Plants, seeds, and gardening supplies were provided. Outcomes Primary outcomes were feasibility targets of 80% accrual and retention, and an absence of serious adverse events; other outcomes were secondary and explored potential benefits. Statistical analyses Baseline to follow-up changes were assessed within and between arms using paired t, McNemar’s, and χ2 tests. Results This trial proved to be safe and demonstrated 91.3% retention; 70% of intervention participants rated their experience as “excellent,” and 85% would “do it again.” Data suggest significantly increased reassurance of worth (+0.49 vs −0.45) and attenuated increases in waist circumference (+2.30 cm vs +7.96 cm) in the gardening vs control arms (P=0.02). Vegetable and fruit consumption increased by approximately 1 serving/day within the gardening arm from baseline to follow-up (mean [standard error]=1.34 [1.2] to 2.25 [1.9] servings/day; P=0.02)] compared to controls (1.22 [1.1] to 1.12 [0.7]; P=0.77; between-arm P=0.06). Conclusions The home vegetable gardening intervention among older cancer survivors was feasible and suggested improvements in vegetable and fruit consumption and reassurance of worth; data also suggest attenuated increases in waist circumference. Continued study of vegetable gardening interventions is warranted to improve health, health behaviors, and well-being of older cancer survivors.
Prevalence and Predictors of Low Serum 25-Hydroxyvitamin D among Female African-American Breast Cancer Survivors J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2018-01-02 Patricia Sheean, Claudia Arroyo, Jennifer Woo, Linda Schiffer, Melinda Stolley
Background African-American breast cancer survivors commonly demonstrate low serum 25-hydroxyvitamin D (25(OH)D). Decreased cutaneous conversion, high levels of adiposity, and even breast cancer treatment may influence vitamin D status. Previous investigations have analyzed African-American women in aggregate with other breast cancer survivors and have not comprehensively addressed these influential factors. Objectives To determine the prevalence of low serum 25(OH)D in an exclusively African-American cohort of female breast cancer survivors with overweight/obesity and to evaluate the role of ultraviolet (UV) light exposure, body composition, and dietary sources of vitamin D on serum 25(OH)D levels. Design Cross-sectional. Participants Pre- and postmenopausal African-American breast cancer survivors (n=244) were recruited from various neighborhoods in the city of Chicago, IL, between September 2011 and September 2014 for a larger weight loss trial. Main outcome measures Demographic, clinical, anthropometric (body mass index [calculated as kg/m2], waist circumference, and hip circumference), blood specimen, dietary intake (food frequency questionnaire), and sun behavior data were collected by trained study personnel before trial participation. Dual-energy x-ray absorptiometry was used to quantify adiposity (total, percentage, regional, visceral) and lean mass. Serum 25(OH)D was used as the biomarker reflective of vitamin D status. Statistical analyses Mean (±standard deviation), frequencies, and multivariate linear regression modeling. Results The average participant was 57.4 years old (±10.0), 6.9 years (±5.2) from initial breast cancer diagnosis with a body mass index of 36.2 (±6.2). The majority of participants (60%) reported habitual oral vitamin D supplementation with mean intake of 327 IU (±169). Vitamin D deficiency was prevalent in 81% and 43%, when the cut points of the Endocrine Society (<30 ng/mL or <75 nmol/L) and the Institute of Medicine (<20 ng/mL or <50 nmol/L) were applied, respectively. A multivariate model adjusting for age, seasonality of blood draw, total energy intake, use of supplemental vitamin D, darker skin pigmentation, breast cancer stage, and waist-to-hip ratio was able to explain 28.8% of the observed variance in serum 25(OH)D concentrations. No significant associations were detected for body mass index or any dual-energy x-ray absorptiometry measures of body composition. Conclusions Considering the number of women who endorsed use of vitamin D supplementation, the prevalence of vitamin D deficiency among these African-American breast cancer survivors was high. Vitamin D supplementation, sun behavior, and waist-to-hip ratio may serve as future points of intervention to improve the vitamin D status of this minority survivor population.
Questioning the Dietary Acculturation Paradox: A Mixed-Methods Study of the Relationship between Food and Ethnic Identity in a Group of Mexican-American Women J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2017-12-28 A. Susana Ramírez, Tanya Golash-Boza, Jennifer B. Unger, Lourdes Baezconde-Garbanati
Background Epidemiological studies have described an “acculturation paradox.” Increased acculturation to the United States is associated with increased consumption of dietary fat and decreased consumption of fruits/vegetables. Objective To expand understanding of the dietary acculturation paradox, this study examined how bicultural Mexican-American women construct ethnic identity and how these identities and identity-making processes relate to perceptions of health and nutrition. Design We utilized embedded mixed methods (in-depth interviews; survey). Participants/setting We analyzed a purposive sample of English-speaking Mexican-American women aged 18 to 29 years (n=24) in rural California to assess ethnic identity and diet beliefs. Results Participants described food as central to expressing cultural identity, usually in terms of family interactions. Mexican food traditions were characterized as unhealthy; many preferred American foods, which were seen as healthier. Specifically, Mexican-American women perceived Mexican patterns of food preparation and consumption as unhealthy. In addition, traditional Mexican foods described as unhealthy were once considered special-occasion foods. Among the participants who expressed a desire to eat healthfully, to do so meant to reject Mexican ways of eating. Conclusions This study raises questions about the nature of the “dietary acculturation paradox.” While food—the eating of Mexican foods—is central to the maintenance of ethnic identity throughout acculturation, negative perceptions about the healthfulness of Mexican foods introduce tension into Mexican-American women’s self-identification. This study suggests a subtle contradiction that may help to explain the dietary acculturation paradox: While previous research has suggested that as Mexicans acculturate to the United States they adopt unhealthy diets, this study finds evidence that they do so at least in part due to perceptions that American diets are healthier than Mexican diets. Implications for interventions to improve Latinos’ diets include an emphasis on the family and use of Spanish linguistic cues. Finally, messages that simply advocate for “traditional” diets should be reconsidered because that message is discordant with perceptions of the healthfulness of such foods.
Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice in Nutrition Care and Standards of Professional Performance for Nutrition and Dietetics Technicians, Registered J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2017-12-24
Nutrition and dietetics technicians, registered (NDTRs) face complex situations every day. Competently addressing the unique needs of each situation and applying standards appropriately are essential to providing safe, timely patient-/client-/customer-centered quality nutrition and dietetics care and services. The Academy of Nutrition and Dietetics (Academy) leads the profession by developing standards that can be used by NDTRs (who are credentialed by the Commission on Dietetic Registration) for self-evaluation to assess quality of practice and performance. The Standards of Practice reflect the NDTR’s role under the supervision of registered dietitian nutritionists in nutrition screening and the Nutrition Care Process and workflow elements, which includes nutrition screening, nutrition assessment, nutrition diagnosis, nutrition intervention/plan of care, nutrition monitoring and evaluation, and discharge planning and transitions of care. The Standards of Professional Performance consist of six domains of professional performance: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, indicators provide measurable action statements that illustrate how the standard can be applied to practice. The Academy’s Revised 2017 Standards of Practice and Standards of Professional Performance for NDTRs along with the Academy/Commission on Dietetic Registration Code of Ethics, and the Scope of Practice for the NDTR provide minimum standards and tools for demonstrating competence and safe practice, and are used collectively to gauge and guide an NDTR’s performance in nutrition and dietetics practice.
Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Nutrition and Dietetics Technician, Registered J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2017-12-24 Denise Andersen, Shari Baird, Denise L. Chapel, Alana D. Cline, Shyamala N. Ganesh, Margaret Garner, Barbara L. Grant, Kathryn K. Hamilton, Krista Jablonski, Sherri L. Jones, Alexandra G. Kazaks, Susan H. Konek, Kelly K. Leonard, Kimi G. McAdam, Beth N. Ogata, Egondu M. Onuoha, Gretchen Y. Robinson, Darrin W. Schmidt, Nancy G. Walters, Pauline Williams, Pamela Wu, Karen Hui, Carol Gilmore, Mujahed Khan, Dana Buelsing, Sharon M. McCauley
The Academy of Nutrition and Dietetics (Academy) is the world’s largest organization of food and nutrition professionals and the association that represents credentialed nutrition and dietetics practitioners—nutrition and dietetics technicians, registered (NDTRs) and registered dietitian nutritionists (RDNs). An NDTR’s scope of practice in nutrition and dietetics has flexible boundaries to capture the depth and breadth of the individual's practice. The NDTR’s practice expands with advances in many areas, including nutrition, food production, food safety, food systems management, health care, public health, community health, and information and communication technology. The Revised 2017 Scope of Practice for the NDTR reflects the position of the Academy on the essential role of the NDTR in the management and delivery of food and nutrition services. The scope of practice for the NDTR is composed of education and credentialing, practice resources, Academy Standards of Practice and Standards of Professional Performance, codes of ethics, accreditation standards, state and federal regulations, national guidelines, and organizational policy and procedures. The Revised 2017 Scope of Practice for the NDTR is used in conjunction with the Revised 2017 Standards of Practice in Nutrition Care and the Standards of Professional Performance for NDTRs. The Standards of Practice address activities related to direct patient and client care. The Standards of Professional Performance address behaviors related to the technical role of NDTRs. These standards reflect the minimum competent level of nutrition and dietetics practice and professional performance for NDTRs. A companion document addresses the scope of practice for the RDN.
Associations of Alcoholic Beverage Consumption with Dietary Intake, Waist Circumference, and Body Mass Index in US Adults: National Health and Nutrition Examination Survey 2003-2012 J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2017-12-22 Lauren Butler, Barry M. Popkin, Jennifer M. Poti
Background Findings from studies of alcohol and obesity measures (eg, waist circumference [WC] and body mass index [BMI; calculated as kg/m2]) are conflicting. Residual confounding by dietary intake, inconsistent definitions of alcohol consumption across studies, and the inclusion of former drinkers in the nondrinking comparison group can contribute to the mixed literature. Objective This study examines associations of alcoholic beverage consumption with dietary intake, WC, and BMI. Design Cross-sectional data from the 2003-2012 National Health and Nutrition Examination Survey were analyzed. Participants/setting Adults 20 to 79 years of age (n=7,436 men; n=6,939 women) were studied. Main outcome measures Associations of alcoholic beverage consumption with energy (kcal), macronutrient and sugar intakes (% kcal), WC, and BMI were determined. Statistical analyses performed Multivariable linear regression models were used to determine associations of average daily volume and drinking quantity (ie, drinks per drinking day) with dietary intake and obesity measures. Former and never drinkers were analyzed as distinct categories; associations of drinking with WC and BMI were examined with and without adjustment for dietary intake variables. Results Heavier-drinking men (≥3 drinks/day) and women (≥2 drinks/day) consumed less nonalcoholic energy (β −252 kcal/day, 95% CI −346 to −159 kcal/day and β −159 kcal/day, 95% CI −245 to −73 kcal/day, respectively) than moderate drinkers (1 to 2 drinks/day in men and 1 drink/day in women). By average daily drinking volume, differences in WC and BMI between former and moderate drinkers were +1.78 cm (95% CI 0.51 to 3.05 cm) and +0.65 (95% CI 0.12 to 1.18) in men and +4.67 cm (95% CI 2.95 to 6.39 cm) and +2.49 (95% CI 1.64 to 3.34) in women. Compared with moderate drinking, heavier drinking volume was not associated with WC or BMI among men or women. In men, drinking ≥5 drinks/drinking day was associated with higher WC (β 3.48 cm, 95% CI 1.97 to 5.00 cm) and BMI (β 1.39, 95% CI 0.79 to 2.00) compared with men who consumed 1 to 2 drinks/drinking day. In women, WC and BMI were not significantly different for women drinking ≥4 drinks/drinking day compared with 1 drink/drinking day. Conclusions Differences in dietary intake across drinking subgroups and separation of former drinkers from nondrinkers should be considered in studies of alcohol intake in relation to WC and BMI.
Colonic Mucosal Bacteria Are Associated with Inter-Individual Variability in Serum Carotenoid Concentrations J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2017-12-21 Zora Djuric, Christine M. Bassis, Melissa A. Plegue, Jianwei Ren, Rena Chan, ElKhansa Sidahmed, D. Kim Turgeon, Mack T. Ruffin IV, Ikuko Kato, Ananda Sen
Background Relatively high serum carotenoid levels are associated with reduced risks of chronic diseases, but inter-individual variability in serum carotenoid concentrations is modestly explained by diet. The bacterial community in the colon could contribute to the bioaccessibility of carotenoids by completing digestion of plant cells walls and by modulating intestinal permeability. Objective To evaluate whether colonic bacterial composition is associated with serum and colon carotenoid concentrations. Design The study was a randomized dietary intervention trial in healthy individuals who were at increased risk of colon cancer. Colon mucosal biopsy samples were obtained before and after 6 months of intervention without prior preparation of the bowels. Participants/setting Participants were recruited from Ann Arbor, MI, and nearby areas from July 2007 to November 2010. Biopsy data were available from 88 participants at baseline and 82 participants after 6 months. Methods Study participants were randomized to counseling for either a Mediterranean diet or a Healthy Eating diet for 6 months. Results At baseline, bacterial communities in biopsy samples from study participants in the highest vs the lowest tertile of total serum carotenoid levels differed by several parameters. Linear discriminant analysis effect size identified 11 operational taxonomic units that were significantly associated with higher serum carotenoid levels. In linear regression analyses, three of these accounted for an additional 12% of the variance in serum total carotenoid concentrations after including body mass index, smoking, and dietary intakes in the model. These factors together explained 36% of the inter-individual variance in serum total carotenoid concentrations. The bacterial community in the colonic mucosa, however, was resistant to change after dietary intervention with either a Mediterranean diet or Healthy Eating diet, each of which doubled fruit and vegetable intakes. Conclusions The colonic mucosal bacterial community was associated with serum carotenoid concentrations at baseline but was not appreciably changed by dietary intervention.
Barriers and Strategies for Healthy Food Choices among American Indian Tribal College Students: A Qualitative Analysis J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2017-10-20 Jill F. Keith, Sherri Stastny, Ardith Brunt, Wanda Agnew
Background American Indian and Alaskan Native individuals experience disproportionate levels of chronic health conditions such as type 2 diabetes and overweight and obesity that are influenced by dietary patterns and food choices. Understanding factors that influence healthy food choices among tribal college students can enrich education and programs that target dietary intake. Objective To build an understanding of factors that influence healthy food choices among tribal college students at increased risk for college attrition. Design A nonexperimental cohort design was used for qualitative descriptive analysis. Participants/setting Participants (N=20) were purposively sampled, newly enrolled, academically underprepared tribal college students enrolled in a culturally relevant life skills course at an upper Midwest tribal college between September 2013 and May 2015. Participant demographic characteristics included various tribal affiliations, ages, and number of dependents. Main outcome measures Participant responses to qualitative research questions about dietary intake, food choices, self-efficacy for healthy food choices, psychosocial determinants, and barriers to healthy food choices during telephone interviews were used as measures. Analysis Qualitative analysis included prestudy identification of researcher bias/assumptions, audiorecording and transcription, initial analysis (coding), secondary analysis (sorting and identifying meaning), and verification (comparative pattern analysis). Results Qualitative analysis revealed a variety of themes and subthemes about healthy food choices. Main themes related to barriers included taste, food gathering and preparation, and difficulty clarifying healthy food choices. Main themes related to strategies included taste, cultural traditions and practices, and personal motivation factors. Conclusions Qualitative analysis identified barrier and strategy themes that may assist nutrition and dietetics practitioners working with tribal/indigenous communities, tribal college educators and health specialists, and tribal community health workers who target health and dietary intake of American Indian and Alaskan Native students.
Diet Quality, Inflammation, and Quality of Life in Breast Cancer Survivors: A Cross-Sectional Analysis of Pilot Study Data J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2017-12-09 Tonya S. Orchard, Rebecca R. Andridge, Lisa D. Yee, Maryam B. Lustberg
Background Modifiable lifestyle factors, such as diet quality, could reduce inflammation and improve quality of life (QOL) in breast cancer survivors, but data are inconclusive. Objective To determine whether diet quality, as measured by Healthy Eating Index-2010 (HEI-2010) score, is associated with inflammation, health status, or functional outcomes affecting QOL in survivors of early-stage breast cancer. Design This is a cross-sectional, secondary analysis of baseline data collected from breast cancer survivors after completion of primary therapy and before random assignment to a pilot nutritional intervention aimed at reducing side effects of aromatase inhibitor treatment. Participants/setting Participants were 44 postmenopausal women with stage I to III endocrine receptor–positive breast cancer receiving outpatient care at a midwestern cancer center between November 2011 and October 2013. Main outcome measures Primary outcomes were serum proinflammatory cytokines (interleukin-6 [IL-6], IL-17, and tumor necrosis factor-α receptor 2 [TNFR-2]). Secondary outcomes included QOL measured by the Stanford Health and Disability Questionnaire and the Functional Assessment of Cancer Therapy–Breast with Endocrine Subscale. Statistical analyses performed Pearson correlation coefficients (r) and linear regression models were used to evaluate the relationship of dietary variables with inflammatory cytokines and QOL measures. Results A higher overall HEI-2010 score (healthier diet) was associated with lower IL-6 (r=−0.46; P=0.002) and TNFR-2 (r=−0.41; P=0.006); however, associations were attenuated by body mass index (BMI) (IL=6 [r=−0.26; P=0.10]; TNFR-2 [r=−0.30; P=0.06]). In women with prior chemotherapy, a higher HEI-2010 score was strongly associated with lower IL-6 (r=−0.67; P=0.009) and TNFR-2 (r=−0.59; P=0.03) after BMI adjustment. There were no significant correlations between HEI-2010 score and QOL measures after adjustment for BMI. Conclusions These data suggest the need for more rigorous investigation into the relationship of diet quality, BMI, and inflammation in breast cancer survivors.
Prevalence of and Differences in Salad Bar Implementation in Rural Versus Urban Arizona Schools J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2017-12-01 Michelle Blumenschine, Marc Adams, Meg Bruening
Background Rural children consume more calories per day on average than urban children, and they are less likely to consume fruit. Self-service salad bars have been proposed as an effective approach to better meet the National School Lunch Program’s fruit and vegetable recommendations. No studies have examined how rural and urban schools differ in the implementation of school salad bars. Objective To compare the prevalence of school-lunch salad bars and differences in implementation between urban and rural Arizona schools. Design Secondary analysis of a cross-sectional web-based survey. Participants/setting School nutrition managers (N=596) in the state of Arizona. Main outcomes measured National Center for Education Statistics locale codes defined rural and urban classifications. Barriers to salad bar implementation were examined among schools that have never had, once had, and currently have a school salad bar. Promotional practices were examined among schools that once had and currently have a school salad bar. Statistical analyses performed Generalized estimating equation models were used to compare urban and rural differences in presence and implementation of salad bars, adjusting for school-level demographics and the clustering of schools within districts. Results After adjustment, the prevalence of salad bars did not differ between urban and rural schools (46.9%±4.3% vs 46.8%±8.5%, respectively). Rural schools without salad bars more often reported perceived food waste and cost of produce as barriers to implementing salad bars, and funding was a necessary resource for offering a salad bar in the future, as compared with urban schools (P<0.05). No other geographic differences were observed in reported salad bar promotion, challenges, or resources among schools that currently have or once had a salad bar. Conclusions After adjustment, salad bar prevalence, implementation practices, and concerns are similar across geographic settings. Future research is needed to investigate methods to address cost and food waste concerns in rural areas.
Attitude and Behavior Factors Associated with Front-of-Package Label Use with Label Users Making Accurate Product Nutrition Assessments J. Acad. Nutr. Diet. (IF 3.399) Pub Date : 2017-12-01 Mary G. Roseman, Hyun-Woo Joung, Emily I. Littlejohn
Background Front-of-package (FOP) labels are increasing in popularity on retail products. Reductive FOP labels provide nutrient-specific information, whereas evaluative FOP labels summarize nutrient information through icons. Better understanding of consumer behavior regarding FOP labels is beneficial to increasing consumer use of nutrition labeling when making grocery purchasing decisions. Objective We aimed to determine FOP label format effectiveness in aiding consumers at assessing nutrient density of food products. In addition, we sought to determine relationships between FOP label use and attitude toward healthy eating, diet self-assessment, self-reported health and nutrition knowledge, and label and shopping behaviors. Design A between-subjects experimental design was employed. Participants were randomly assigned to one of four label conditions: Facts Up Front, Facts Up Front Extended, a binary symbol, and no-label control. Participants/setting One hundred sixty-one US primary grocery shoppers, aged 18 to 69 years. Participants were randomly invited to the online study. Intervention Participants in one of four label condition groups viewed three product categories (cereal, dairy, and snacks) with corresponding questions. Main outcome measures Adults’ nutrition assessment of food products based on different FOP label formats, along with label use and attitude toward healthy eating, diet self-assessment, self-reported health and nutrition knowledge, and label and shopping behaviors. Statistical analyses performed Data analyses included descriptive statistics, χ2 tests, and logistical regression. Significant outcomes were set to α=.05. Results Participants selected the more nutrient-dense product in the snack food category when it contained an FOP label. Subjective health and nutrition knowledge and frequency of selecting food for healthful reasons were associated with FOP label use (P<0.01 and P<0.05, respectively). Conclusions Both Facts Up Front (reductive) and binary (evaluative) FOP labels appear effective for nutrition assessment of snack products compared with no label. Specific attitude and behavior factors were associated with label use.
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- Acc. Chem. Res.
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- Acta Biomater.
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- Appl. Catal. A Gen.
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- Compos. Sci. Technol.
- Compr. Rev. Food Sci. Food Saf.
- Comput. Chem. Eng.
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- Coordin. Chem. Rev.
- Corros. Sci.
- Crit. Rev. Food Sci. Nutr.
- Crit. Rev. Solid State Mater. Sci.
- Cryst. Growth Des.
- Curr. Opin. Chem. Eng.
- Curr. Opin. Colloid Interface Sci.
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- Eur. J. Inorg. Chem.
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- Eur. J. Org. Chem.
- Eur. Polym. J.
- J. Acad. Nutr. Diet.
- J. Agric. Food Chem.
- J. Alloys Compd.
- J. Am. Ceram. Soc.
- J. Am. Chem. Soc.
- J. Am. Soc. Mass Spectrom.
- J. Anal. Appl. Pyrol.
- J. Anal. At. Spectrom.
- J. Antibiot.
- J. Catal.
- J. Chem. Educ.
- J. Chem. Eng. Data
- J. Chem. Inf. Model.
- J. Chem. Phys.
- J. Chem. Theory Comput.
- J. Chromatogr. A
- J. Chromatogr. B
- J. Clean. Prod.
- J. CO2 UTIL.
- J. Colloid Interface Sci.
- J. Comput. Chem.
- J. Cryst. Growth
- J. Dairy Sci.
- J. Electroanal. Chem.
- J. Electrochem. Soc.
- J. Environ. Manage.
- J. Eur. Ceram. Soc.
- J. Fluorine Chem.
- J. Food Drug Anal.
- J. Food Eng.
- J. Food Sci.
- J. Funct. Foods
- J. Hazard. Mater.
- J. Heterocycl. Chem.
- J. Hydrol.
- J. Ind. Eng. Chem.
- J. Inorg. Biochem.
- J. Magn. Magn. Mater.
- J. Mater. Chem. A
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- J. Membr. Sci.
- J. Mol. Catal. A Chem.
- J. Mol. Liq.
- J. Nat. Gas Sci. Eng.
- J. Nat. Prod.
- J. Nucl. Mater.
- J. Org. Chem.
- J. Photochem. Photobiol. C Photochem. Rev.
- J. Phys. Chem. A
- J. Phys. Chem. B
- J. Phys. Chem. C
- J. Phys. Chem. Lett.
- J. Polym. Sci. A Polym. Chem.
- J. Porphyr. Phthalocyanines
- J. Power Sources
- J. Solid State Chem.
- J. Taiwan Inst. Chem. E.
- Macromol. Rapid Commun.
- Mass Spectrom. Rev.
- Mater. Chem. Front.
- Mater. Des.
- Mater. Horiz.
- Mater. Lett.
- Mater. Sci. Eng. A
- Mater. Sci. Eng. R Rep.
- Mater. Today
- Meat Sci.
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- Mol. Biosyst.
- Mol. Cancer Ther.
- Mol. Catal.
- Mol. Nutr. Food Res.
- Mol. Pharmaceutics
- Mol. Syst. Des. Eng.
- Nano Energy
- Nano Lett.
- Nano Res.
- Nano Today
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- Nanomed. Nanotech. Biol. Med.
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- Nat. Catal.
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- Nat. Commun.
- Nat. Energy
- Nat. Mater.
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- Nat. Nanotech.
- Nat. Photon.
- Nat. Prod. Rep.
- Nat. Protoc.
- Nat. Rev. Chem.
- Nat. Rev. Drug. Disc.
- Nat. Rev. Mater.
- Natl. Sci. Rev.
- Neurochem. Int.
- New J. Chem.
- NPG Asia Mater.
- npj 2D Mater. Appl.
- npj Comput. Mater.
- npj Flex. Electron.
- npj Mater. Degrad.
- npj Sci. Food
- Pharmacol. Rev.
- Pharmacol. Therapeut.
- Photochem. Photobiol. Sci.
- Phys. Chem. Chem. Phys.
- Phys. Life Rev.
- PLOS ONE
- Polym. Chem.
- Polym. Degrad. Stabil.
- Polym. J.
- Polym. Rev.
- Powder Technol.
- Proc. Combust. Inst.
- Prog. Cryst. Growth Ch. Mater.
- Prog. Energy Combust. Sci.
- Prog. Mater. Sci.
- Prog. Photovoltaics
- Prog. Polym. Sci.
- Prog. Solid State Chem.