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  • Urban Food Supply Chain Resilience for Crises Threatening Food Security: A Qualitative Study
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-12-06
    Amelie A. Hecht, Erin Biehl, Daniel J. Barnett, Roni A. Neff

    Background Businesses and organizations involved in growing, distributing, and supplying food may face severe disruptions from natural and human-generated hazards, ranging from extreme weather to political unrest. Baltimore, Maryland, is developing policies to improve local food system organizations’ ability to prepare for, respond to, and recover from disruptive events and ultimately to contribute to food system resilience. Objectives To identify factors that may be associated with organization-level food system resilience, how these factors may play out in disaster response, and how they may relate to organizations’ confidence in their ability to withstand disruptive events. Design Semi-structured in-depth interviews with representatives of key food system businesses and organizations identified by means of stratified purposive sampling and snowball sampling. Participants/setting Representatives of 26 food system businesses and organizations in Baltimore stratified by two informant categories: organizations focused on promoting food access, such as governmental offices and nonprofits, and businesses and organizations involved in supplying and distributing food in Baltimore City, such as retailers, wholesalers, and producers. Analyses Interviews were analyzed using a phronetic iterative approach. Results The following 10 factors that may contribute to organization-level resilience were identified: formal emergency planning; staff training; staff attendance; redundancy of food supply, food suppliers, infrastructure, location, and service providers; insurance; and post-event learning. Organizations that were larger, better resourced, and affiliated with national or government partners typically demonstrated more resilience factors compared with smaller, independent, and nonprofit organizations. Conclusion To ensure reliable access to safe food for all people, food system organizations must strengthen their operations to safeguard against a variety of potential threats. This study’s examination of factors that contribute to resilience can help food system organizations, researchers, and government officials identify priorities for investigating vulnerabilities in diverse operations and potential strategies to improve resilience in the face of ongoing and growing threats.

    更新日期:2018-12-06
  • Poor Nutritional Status among Low-Income Older Adults: Examining the Interconnection between Self-Care Capacity, Food Insecurity, and Depression
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-06-18
    Seung Eun Jung, Seoyoun Kim, Alex Bishop, Janice Hermann

    Background Understanding of the mechanisms of how food insecurity and poor physical and mental health status are interrelated with nutritional status among older adults is needed due to their unique health and social needs. Objective To examine the complex relationships between self-care capacity, depressive symptoms, food insecurity, and nutritional status among low-income older adults. Design The cross-sectional study was conducted from February 2017 to May 2017. Participants/setting A total of 372 low-income older adults, 60 years of age and older, living in the state of Alabama participated. Main outcome measures Participants completed a validated survey measuring food insecurity (six-item US Food Security Survey Module), self-care capacity (Self-Care Capacity Scale), depressive symptoms (10-item Geriatric Depression Scale), and nutritional status (Mini Nutritional Assessment Short-Form). Statistical analyses performed Generalized structural equation modeling was used to include the simultaneous equations and multiple mediators in one model. The Akaike Information Criterion, Bayesian Information Criterion, and likelihood ratio tests were conducted to compare the fit of competing model specifications. Results Lower self-care capacity was associated with greater food insecurity (beta [b]=.11, odds ratio [OR]=1.11, P=0.03) and higher depressive symptoms (b=.08, P=0.005). Poorer self-care capacity and higher depressive symptoms were associated with poorer nutritional status (b=.24, OR=1.27, P<0.001; b=.13, OR=1.43, P=0.001, respectively). Higher food insecurity was associated with increased depressive symptoms (b=.40, P<0.001). Self-care capacity was associated with nutritional status directly and indirectly through depressive symptoms (b=.04, P=0.048). Although food insecurity was not significantly associated with nutritional status, a significant indirect association between food insecurity and nutritional status through depressive symptoms was observed (b=.02, P=0.04). Conclusions Study results indicate functionally impaired low-income older adults encounter greater food insecurity. Inability to afford food combined with limited ability to take care of oneself contributes to an increased self-report of depressive symptoms, resulting in less favorable nutritional status.

    更新日期:2018-11-29
  • A Cluster-Randomized Trial of a Mobile Produce Market Program in 12 Communities in North Carolina: Program Development, Methods, and Baseline Characteristics
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-06-23
    Lucia A. Leone, Gina L. Tripicchio, Lindsey Haynes-Maslow, Jared McGuirt, Jaqueline S. Grady Smith, Janelle Armstrong-Brown, Sarah D. Kowitt, Ziya Gizlice, Alice S. Ammerman

    Background Mobile markets are an increasingly popular method for providing access to fresh fruits and vegetables (F/V) in underserved communities; however, evaluation of these programs is limited, as are descriptions of their development, study designs, and needs of the populations they serve. Objective Our aim was to describe the development and theoretical basis for Veggie Van (VV), a mobile produce market intervention, the study design for the VV evaluation, and baseline characteristics of the study population. Design The protocol and sample for a cluster-randomized controlled trial with 12 sites are described. Participants/setting Community partner organizations in the Triangle region of North Carolina that primarily served lower-income families or were located in areas that had limited access to fresh produce were recruited. Eligible individuals at each site (older than 18 years of age, self-identified as the main shoppers for their household, and expressed interest in using a mobile market) were targeted for enrollment. A total of 201 participants at 12 sites participated in the VV program and evaluation, which was implemented from November 2013 to March 2016. Main outcome measures Change in F/V intake (cups/day), derived from self-reported responses to the National Cancer Institute F/V screener, was the main outcome measure. Statistical analyses performed We performed a descriptive analysis of baseline sample characteristics. Results Mean reported F/V intake was 3.4 cups/day. Participants reported generally having some access to fresh F/V, and 57.7% agreed they could afford enough F/V to feed their family. The most frequently cited barriers were cost (55.7%) and time to prepare F/V (20.4%). Self-efficacy was lowest for buying more F/V than usual and trying new vegetables. Conclusions By addressing cost and convenience and building skills for purchasing and preparing F/V, the VV has the potential to improve F/V consumption in underserved communities.

    更新日期:2018-11-29
  • Role of Drill Sergeants in Nutrition Behaviors of Soldiers in Basic Combat Training
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-07-27
    Julianna M. Jayne, Barbara K. Bujak, Toni M. Torres-McGehee, Edward A. Frongillo, Sonya J. Cable, Saundra H. Glover, Dawn M. Emerson, Christine E. Blake

    Background In the US Army, soldiers’ nutrition behaviors have a direct impact on their performance. The emphasis in basic combat training is on “soldierization” (transforming a civilian into a soldier), and drill sergeants are instrumental in this process. Limited information about how drill sergeants use their influence to have an impact on nutrition behaviors of new soldiers is available. Objective This study aimed to determine nutrition attitudes, beliefs, and knowledge of drill sergeants; the ways drill sergeants instill new soldiers with an army identity (eg, warrior athlete, army strong); and how healthy eating is perceived to fit with this new identity. Design This qualitative, phenomenological study used in-depth interviews conducted with army drill sergeants at two southeast US Army posts between July and August 2011 (n=30). Main outcome measures Interviews emphasized drill sergeants’ perceptions of the eating environment during basic training, the drill sergeant role, and drill sergeants' main duties. Data analysis An iterative process of group coding using a constant comparative method was used to find distinct themes. Data were analyzed using qualitative data analysis software. Results Drill sergeants described their main duty as training new soldiers. Drill sergeants identified the ideal soldier as lean and physically fit but did not identify training soldiers how to eat to become the ideal soldier as part of their duties. Confusion about nutrition concepts was common. Overall, drill sergeants recognized that what soldiers eat affects their physical performance and appearance, but they did not see helping soldiers establish healthy eating behaviors as one of their duties or responsibilities during basic combat training. Conclusions Drill sergeants are key individuals in the process by which new recruits develop a soldier identity. Additional resources are necessary to help drill sergeants emphasize nutrition and health during basic combat training and help them guide soldiers toward adopting healthy eating as part of their soldier identity to improve weight management, health, and performance.

    更新日期:2018-11-29
  • Monthly Variations in Dietary Intake of Women Participating in the Supplemental Nutrition Assistance Program
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-07-29
    Namrata Sanjeevi, Jeanne Freeland-Graves

    Background Households participating in the Supplemental Nutrition Assistance Program (SNAP) have been shown to spend the majority of their program benefits within the first 3 days of receipt. Hence, it is important to investigate dietary intakes of SNAP participants based on time since receipt of benefits. Objective The objectives of this study were to investigate the dietary intake of women participating in SNAP over 1 month and to compare diet quality between food secure and food insecure women using two indices. Design A longitudinal design was used to examine monthly dietary intake of women in SNAP. Participants were measured for height and weight. A demographics questionnaire and a food frequency questionnaire (FFQ) based on a reference period of 1 week were administered. The FFQ was completed four times, with an interval of 1 week, so that it reflected the diets of participants during weeks 1, 2, 3, and 4 of benefit receipt. Participants also completed the US adult food security module. The Healthy Eating Index-2010 and the Dietary Guidelines Adherence Index 2015 were used to assess diet quality. Participants/setting A total of 217 women were recruited from low-income housing and neighborhood centers in Central Texas from January to December 2015. Women enrolled in SNAP, aged 18 to 50 years, and of Hispanic, African-American, and white race or ethnicity participated in the study. Fifty-eight women were lost during follow-up. Data from eight participants was excluded due to reporting of implausible caloric intakes, thereby resulting in a final sample of 151. Main outcome measures Food group, nutrient intake, and diet quality were the main outcome measures of the study. Statistical analysis A mixed linear model was conducted using week since receipt of benefits as the independent variable and food group, nutrient intake, and diet quality as the dependent variables. An analysis of variance was conducted to determine differences in diet quality based on food security status for each week of the monthly SNAP cycle. Results A significant decrease in daily intakes of fruits, vegetables, dairy, and diet quality was observed over the month (P<0.05, with Bonferroni adjustment). Food secure women had higher diet quality than those with very low food security (P<0.05, with Bonferroni adjustment). However, a decline in diet quality was observed in all groups of women, classified according to food security status. Conclusions These results show that dietary intake of SNAP participants varies based on time since receipt of benefits.

    更新日期:2018-11-29
  • WIC Recipients in the Retail Environment: A Qualitative Study Assessing Customer Experience and Satisfaction
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-11-27
    Christina Chauvenet, Molly De Marco, Carolyn Barnes, Alice S. Ammerman

    BackgroundThe Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program is an important intervention for prevention and treatment of obesity and food insecurity, but participation has dropped among eligible populations from 2009 to 2015. Program satisfaction is integral to participant retention, and the retail experience is a vital component of program satisfaction.ObjectiveThis article applies behavioral economics principles to explore the retail experience of WIC participants and ways in which it may be improved.DesignThe authors designed and conducted semistructured interviews and focus groups with WIC participants.Participants/settingA convenience sample of WIC participants aged 18 years and older were recruited through WIC clinics in Texas, North Carolina, Oregon, and Illinois (n=55, 27 participants from four focus groups and 28 individual interviews).Statistical analysis conductedResponses were analyzed qualitatively using principles of content analysis.ResultsChallenges in identifying WIC-allowable items throughout the store as well as perceived stigmatization during the checkout process were the chief complaints. Study participants described a learning curve in successful use of WIC in retail environments over time. Study participants also reported acceptance of restrictions, such as a requirement to purchase the least expensive brand.ConclusionsDissatisfaction with the retail experience may lead to the underutilization of WIC benefits or program exit. Behavioral economics strategies that facilitate a better shopping experience, such as creating a section for WIC items in the store or improving in-store education, may improve the retail experience for WIC customers. Further research is needed to ensure such strategies are effective and do not contribute to stigma.

    更新日期:2018-11-28
  • Establishing Validity and Cross-Context Equivalence of Measures and Indicators
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-11-22
    Edward A. Frongillo, Tom Baranowski, Amy F. Subar, Janet A. Tooze, Sharon I. Kirkpatrick

    Quantitative research depends on using measures to collect data that are valid (ie, reflect well the phenomena of interest) and perform equivalently across contexts. Demonstrating validity and cross-context equivalence requires specifically designed studies, but many such studies have problems that have limited their usefulness. This article explains validity and cross-context equivalence of measures (and important related concepts) and clarifies how to establish them. Validation is the process of determining whether a measure or indicator is suitable for providing useful analytical measurement for a given purpose and context. Cross-context equivalence means that a measure performs comparably across contexts. Four types of equivalence are construct, item, measurement, and scalar. Establishing validity and cross-context equivalence requires representing mathematically the errors (ie, imprecision, undependability, and inaccuracy) of a measure and using appropriate statistical methods to quantify these errors. Studies aiming to provide evidence about the validity of a measure need to clarify the purpose and context for use of that measure. Choose one of the two conceptual systems for validation; obtain data to establish the extent to which the measure is well constructed, reliable, and accurate; and use analytic methods beyond simple correlations to provide a basis for making reasoned judgment about whether the measure provides useful analytic measurement for the particular purpose(s) and context. Establishing accuracy of a measure requires having available other measures known to be accurate as comparators; in the case that no other measure understood to be more accurate is available, then the study will be able to establish agreement rather than validity.

    更新日期:2018-11-24
  • School Lunch Entrées Before and After Implementation of the Healthy, Hunger-Free Kids Act of 2010
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-11-23
    Lauren Mozer, Donna B. Johnson, Mary Podrabsky, Anita Rocha

    BackgroundThe Healthy, Hunger-Free Kids Act (HHFKA) 2010 updated standards to increase the nutritional quality of school meals. Studies of HHFKA outcomes have focused primarily on fruit and vegetables, nutrient quality of whole meals, and plate waste.ObjectiveTo examine changes in school lunch entrée nutrient quality and student selections after HHFKA implementation.DesignDescriptive, longitudinal study analyzing 1.7 million student-selected lunch entrées in eight entrée categories.Participants/settingThree middle schools and three high schools in an urban school district in Washington State, from January 2011 to January 2014 (16 months before and 15 months after HHFKA implementation).Main outcome measuresNutritional quality of each entrée category was assessed by analyzing mean adequacy ratio, energy density, and energy per serving. Selection was determined by analyzing number of entrées in each category selected by students.Statistical analyses performedComparison of indices of pre- and postimplementation nutritional quality using a combination of Wilcoxon two-sample test with t approximation and a two-sided alternative t test assuming equal variances and t test assuming unequal variances using Satterthwaite approximation. Quantity of entrée categories selected was also determined by Satterthwaite approximation.ResultsAfter implementation, there was significant improvement in mean adequacy ratio and energy per serving overall for all entrées combined. There were significant improvements in both mean adequacy ratio and energy per serving for salads, burritos, and pizza in middle schools and for hot sandwiches and burritos in high schools. For energy density, middle schools also had significant decreases for casseroles and salads, with no significant changes found in high schools. The variety of entrées decreased by 44%, and there were significant changes in the proportions of entrées selected from specific food categories.ConclusionNutritional quality of lunch entrées, variety of entrées available, and student entrée selections changed after implementation of HHFKA policy in one urban school district in Washington State.

    更新日期:2018-11-24
  • Comparison of Label and Laboratory Sodium Values in Popular Sodium-Contributing Foods in the United States
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-11-13
    Jaspreet K.C. Ahuja, Ying Li, Melissa S. Nickle, David B. Haytowitz, Janet Roseland, Quynhanh Nguyen, Mona Khan, Xianli Wu, Meena Somanchi, Juhi Williams, Pamela R. Pehrsson, Mary Cogswell

    BackgroundNutrition labels are important tools for consumers and for supporting public health strategies. Recent, published comparison of label and laboratory sodium values for US foods, and differences by brand type (national or private-label) or source (store or restaurant [fast-food and sit-down]) is unavailable.ObjectiveThe objective was to compare label and laboratory values for sodium and related nutrients (ie, total sugars, total fat, and saturated fat) in popular, sodium-contributing foods, and examine whether there are differences by brand type, and source.DesignDuring 2010 to 2014, the Nutrient Data Laboratory of the US Department of Agriculture collected 3,432 samples nationwide of 125 foods, combined one or more samples of the same food (henceforth referred to as composites), and chemically analyzed them. For this comparative post hoc analysis, the Nutrient Data Laboratory linked laboratory values for 1,390 composites (consisting of one or more samples of the same food) of 114 foods to corresponding label or website (restaurant) nutrient values.Main outcome measuresLabel and laboratory values and their ratio for each composite, for each of the four nutrients (sodium, total fat, total sugars, and saturated fat).Statistical analyses performedNutrient Data Laboratory analysis determined the ratio of laboratory to label value for each composite, and categorized them into six groups: ≥141%, 121% to 140%, 101% to 120%, 81% to 100%, 61% to 80%, and ≤60%. For sodium, the Nutrient Data Laboratory analysis determined the distribution of the ratios by food, food category, brand type, and source.ResultsFor sodium, 5% of the composites had ratios of laboratory to label values >120% and 14% had ratios ≤80%. Twenty-two percent of private-label brand composites had ratios ≤80%, compared with 12% of national brands. Only 3% of store composites had ratios >120% compared with 11% of restaurant composites. Ratios ≤80% were more prevalent among sit-down restaurants (37%) compared with fast-food restaurants (9%).ConclusionsThis study shows that a majority of label and laboratory values sampled agree and underdeclaration of label values is limited. However, there is some disagreement. Periodic monitoring of the nutrient content of foods through laboratory analyses establishes validity of the food labels and helps identify foods and food categories where the label and laboratory values do not compare well, and hence may need laboratory analyses to support accuracy of food composition data.

    更新日期:2018-11-13
  • Daily Patterns of Caffeine Intake and the Association of Intake with Multiple Sociodemographic and Lifestyle Factors in US Adults Based on the NHANES 2007–2012 Surveys
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-11-13
    Harris R. Lieberman, Sanjiv Agarwal, Victor L. Fulgoni

    BackgroundCaffeine increases alertness when consumed in single servings of various products including coffee, tea, soft drinks, and energy drinks. Although not a nutrient, caffeine is consumed by 90% of the adult population in the United States.ObjectiveThis study examined the daily pattern of caffeine intake and its relationship to multiple demographic variables.MethodsData from the National Health and Nutrition Examination Survey (NHANES) 2007–2012 (adults aged 19+ years; n=16,173) were used to determine the time of day at which caffeine is consumed and demographic factors associated with intake. Regression analyses characterized factors associated with caffeine intake including sex, age, ethnicity, education, smoking status, physical activity, employment status, total work hours, alcohol, and energy intake.ResultsMean adult per capita caffeine intake was 169±4 mg/d (mean±standard error). Most caffeine (70%) was consumed before noon, often at breakfast, and intake decreased progressively over the day, with little consumed after 9:00 pm. Intake was associated with age, ethnicity, smoking status, total calorie intake, and work hours (P<0.01) but not physical activity, economic status, education level, or employment status. Variables with the largest associations with intake were, respectively, ethnicity and age. Non-Hispanic black individuals consumed the smallest amounts (80±2 mg/d), non-Hispanic white individuals consumed the greatest amounts (194±3 mg/d), and Asian individuals (126±7 mg/d) and Hispanic individuals consumed intermediate amounts (127±3 mg/d). Middle-aged individuals (aged 50 to 54 years) consumed more caffeine (211±6 mg/d) than younger (107±4 mg/d, aged 20 to 24 years) and older individuals (153±4 mg/d, aged 75 to 79 years).ConclusionMost caffeine is consumed in the morning, when alertness is lowest, and very little in the evening before sleep. Ethnicity and age were the variables most strongly associated with intake; work hours, occupation, energy and alcohol intake, and smoking were also associated with intake. Because caffeine increases alertness, it is not surprising that its pattern of consumption and factors associated with its intake vary from those of most other food constituents.

    更新日期:2018-11-13
  • Fecal Akkermansia muciniphila Is Associated with Body Composition and Microbiota Diversity in Overweight and Obese Women with Breast Cancer Participating in a Presurgical Weight Loss Trial
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-11-09
    Andrew D. Frugé, William Van der Pol, Laura Q. Rogers, Casey D. Morrow, Yuko Tsuruta, Wendy Demark-Wahnefried

    Background Akkermansia muciniphila (AM) is a gram-negative, mucin-degrading bacteria inhabiting the gastrointestinal tract associated with host phenotypes and disease states. Objective Explore characteristics of overweight and obese female early-stage (0 to II) breast cancer patients with low AM relative abundance (LAM) vs high (HAM) enrolled in a presurgical weight-loss trial. Design Secondary analysis of pooled participants in a randomized controlled trial (NCT02224807). Participants/setting During the period from 2014 to 2017, 32 female patients with breast cancer were randomized to weight-loss or attention-control arms from time of diagnosis-to-lumpectomy (mean=30±9 days). Intervention All were instructed to correct nutrient deficiencies via food sources and on upper-body exercises. The weight-loss group received additional guidance to promote 0.5 to 1 kg/wk weight-loss via energy restriction and aerobic exercise. Main outcome measures At baseline and follow-up, sera, fecal samples, two-24 hour dietary recalls and dual x-ray absorptiometry were obtained. Bacterial DNA was isolated from feces and polymerase chain reaction (16S) amplified. Inflammatory cytokines were measured in sera. Statistical analyses performed Differences between LAM and HAM participants were analyzed using t tests and nonparametric tests. Spearman correlations explored relationships between continuous variables. Results Participants were aged 61±9 years with body mass index 34.8±6. Mean AM relative abundance was 0.02% (0.007% to 0.06%) and 1.59% (0.59% to 13.57%) for LAM and HAM participants, respectively. At baseline, women with HAM vs LAM had lower fat mass (38.9±11.2 kg vs 46.4±9.0 kg; P=0.044). Alpha diversity (ie, species richness) was higher in women with HAM (360.8±84.8 vs 282.4±69.6; P=0.008) at baseline, but attenuated after weight-loss (P=0.058). At baseline, interleukin-6 level was associated with species richness (ρ=–0.471, P=0.008) and fat mass (ρ=0.529, P=0.002), but not AM. Change in total dietary fiber was positively associated with AM in LAM (ρ=0.626, P=0.002), but not HAM (ρ=0.436, P=0.180) participants. Conclusions Among women with early-stage breast cancer, body composition is associated with AM, microbiota diversity, and interleukin-6 level. AM may mediate the effects of dietary fiber in improving microbiota composition.

    更新日期:2018-11-09
  • Similar 24-Hour Dietary Recall Results from Low-Income Women When Collected by a Paraprofessional Nutrition Educator or Registered Dietitian Nutritionist
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-11-09
    Susan M.H. Gills, Garry Auld, Ann Hess, Susan S. Baker

    Background The Expanded Food and Nutrition Education Program (EFNEP) is a federally funded, community nutrition education program that assists the low-income population in acquiring knowledge and skills related to nutrition, food safety, food resource management, food security, and physical activity. Evaluation of EFNEP includes a 24-hour dietary recall (24HDR) administered by paraprofessional educators, yet protocols for most large-scale nutrition research studies employ registered dietitian nutritionists (RDNs) or individuals with educational backgrounds in nutrition or related fields to collect dietary recalls. Objective To compare 24HDRs collected by trained paraprofessional educators with recalls collected by an RDN. Design Exploratory cross-over study comparing same-day 24HDR in a one-on-one setting collected by paraprofessional educators and an RDN. Paired recalls were separated by at least 1 hour. Participants and setting The participants (n=41) were volunteer women who were eligible for participation in EFNEP in two states. Main outcome measures The 24HDRs were compared for energy, macronutrients, micronutrients, and food groups. Statistical analysis performed Mixed-model analysis to account for repeated measures. Intraclass correlation and Spearman correlation coefficients to determine interrater agreement. Results No difference in 24HDR was seen when compared by interviewer (paraprofessional vs RDN) or by site (Colorado vs North Carolina). There were significant differences in four components (energy, total fat, saturated fat, and solid fats-added sugar) based on recall order, with a higher intake in the second recall compared with the first. Conclusion The results of this preliminary study suggest that a well-trained paraprofessional educator using a valid methodology can collect a 24HDR that is similar to a recall collected by an RDN. The paraprofessional educator can be employed for dietary data collection, allowing the RDN to focus on more advanced aspects of scope of practice, such as data evaluation and program development.

    更新日期:2018-11-09
  • The Grocery Purchase Quality Index-2016 Performs Similarly to the Healthy Eating Index-2015 in a National Survey of Household Food Purchases
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-11-07
    Philip J. Brewster, Carrie M. Durward, John F. Hurdle, Gregory J. Stoddard, Patricia M. Guenther

    Background Household food purchases are potential indicators of the quality of the home food environment, and grocery purchase behavior is a main focus of US Department of Agriculture (USDA) nutrition education programs; therefore, objective measures of grocery purchases are needed. Objective The objective of the study was to evaluate the Grocery Purchase Quality Index-2016 (GPQI-2016) as a tool for assessing grocery food purchase quality by using the Healthy Eating Index-2015 (HEI-2015) as the reference standard. Design In 2012, the USDA Economic Research Service conducted the National Household Food Acquisition and Purchase Survey. Members of participating households recorded all foods acquired for a week. Foods purchased at stores were mapped to the 29 food categories used in USDA Food Plans, expenditure shares were estimated, and GPQI-2016 scores were calculated. USDA food codes, provided in the survey database, were used to calculate the HEI-2015. Participants/setting All households in the 48 coterminous states were eligible for the survey. The analytic sample size was 4,276 households. Main outcome measures GPQI-2016 and HEI-2015 scores were compared. Statistical analyses performed Correlation of scores was assessed using Spearman’s correlation coefficient. Linear regression models with fixed effects were used to determine differences among various subgroups of households. Results The correlation coefficient for the total GPQI-2016 score and the total HEI-2015 score was 0.70. For the component scores, the strongest correlations were for Total and Whole Fruit (0.89 to 0.90); the weakest were for Dairy (0.67), Refined Grains (0.66), and Sweets and Sodas/Added Sugars (0.65) (all, P<0.01). Both the GPQI-2016 and HEI-2015 were significantly different among subgroups in expected directions. Conclusions Overall, the GPQI-2016, estimated from a national survey of households, performed similarly to the HEI-2015. The tool has potential for evaluating nutrition education programs and retail-oriented interventions when the nutrient content and gram weights of foods purchased are not available.

    更新日期:2018-11-07
  • Baseline Dietary Intake of Individuals with Spinal Cord Injury Who Are Overweight or Obese
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-11-02
    Stephanie L. Silveira, Laurel L. Winter, Rya Clark, Tracey Ledoux, Susan Robinson-Whelen

    Background Individuals with spinal cord injury (SCI) experience significant secondary health conditions including excess adiposity. Dietary guidelines for individuals with chronic SCI do not exist. Objective To describe baseline dietary intake and quality based on conformance with dietary recommendations in participants enrolled in GoHealthySCI, a weight loss intervention for individuals with SCI, which promotes lifestyle change. Design Cross-sectional analyses were conducted on data collected from April through August 2017 in a randomized pilot study. Participants Thirty-seven participants enrolled in the study in Houston, TX. All participants were at least 1 year post injury with a self-reported body mass index (calculated as kg/m2) ≥23. The racially/ethnically diverse sample was predominantly male (n=23), average age was 41.8±13.5 years, and average number of years since injury was 18.1±14.9. Participants varied in terms of level of injury; 19 participants identified as having tetraplegia and 19 identified as having paraplegia. Main outcome measures The Automated Self-Administered 24-Hour Recall dietary assessment was used to obtain baseline dietary intake data. Participants reported food intake on 3 nonconsecutive days. Statistical analysis Descriptive statistics were conducted for the primary research objectives. Mean macronutrient and micronutrient intake and Healthy Eating Index-2015 total and component scores are described. Results Average daily energy intake was 1618±434 kcal. Daily intakes of whole fruits (0.6±0.7 cups), vegetables (1.6±0.9 cups), and whole grains (15%) of total grains were lower than recommendations from the 2015-2020 Dietary Guidelines for Americans. Average daily fiber (15.0g±6.0) met the Academy of Nutrition and Dietetics Evidence Analysis Library minimum target range for individuals with SCI. All percentages of calories from macronutrients were within the acceptable macronutrient distribution ranges: total fat (34.3%±6.2%), protein (16.7%±4.2%), and carbohydrate (49.3%±8.4%). Mean Healthy Eating Index-2015 score was 54.4. Conclusions This study provides a description of dietary intake by individuals with SCI who are overweight or obese. Although macronutrients are within the acceptable distribution range, calories from fat are at the high end and those from protein are at the low end of those ranges. In addition, on average, individuals reported inadequate intake of fruits, vegetables, whole grains, fiber, seafood and plant protein, and healthy fats and excess intake of added sugars and saturated fat. Results provide preliminary evidence of dietary inadequacies and suggest that larger studies examining dietary intake are warranted.

    更新日期:2018-11-05
  • Resemblance of Diet Quality in Families of Youth with Type 1 Diabetes Participating in a Randomized Controlled Behavioral Nutrition Intervention Trial in Boston, MA (2010-2013): A Secondary Data Analysis
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-10-31
    Leah M. Lipsky, Denise L. Haynie, Aiyi Liu, Tonja R. Nansel

    Background Parent–child diet quality resemblance is unknown in families of youth with type 1 diabetes, for whom nutrition is central to disease management. Objective Examine diet quality resemblance in families of youth with type 1 diabetes participating in a behavioral nutrition intervention trial and investigate whether treatment assignment or family meal frequency modifies resemblance. Design This is a secondary data analysis from an 18-month randomized controlled trial conducted August 2010 to May 2013. Participants/setting Parent-youth dyads (N=136, child age=12.3±2.5 years) were recruited from a northeast US diabetes center. Main outcome measures Parent and child Healthy Eating Index-2005 (HEI-2005, reflecting adherence to 2005 Dietary Guidelines for Americans) and whole plant food density (WPFD, reflecting intervention target foods) were calculated from 3-day food records collected every 6 months. Statistical analysis Linear random effects models adjusting for demographics and disease characteristics investigated parent–child diet quality resemblance. Separate models examined whether treatment assignment or family meal frequency modified resemblance. Three-way interaction terms examined whether resemblance changed over time by treatment assignment. Results Time-varying parent and child HEI-2005 and WPFD were positively associated (P<0.001), and there were no interactions with family meals. Parent–child HEI-2005 resemblance was similar across treatment groups; however, parent–child WPFD resemblance was stronger in the intervention (β±standard error [SE]=.30±.06) vs control families (β±SE=.12±.05). Parent–child HEI-2005 resemblance was similar over time by treatment assignment, whereas parent–child WPFD resemblance increased over time for families in the intervention group (three-way interaction term β±SE=.03±.01). Conclusions Parent and youth diet quality were positively correlated in families of youth with type 1 diabetes. Resemblance was stronger in the intervention group for target foods, but not for a general measure of diet quality. The lack of effect modification by family meal frequency suggests that family diet quality resemblance is not contingent on shared meals.

    更新日期:2018-11-02
  • Nutrition Care in Bariatric Surgery: An Academy Evidence Analysis Center Systematic Review
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-11-01
    Laura Andromalos, Nina Crowley, Jennifer Brown, Lillian Craggs-Dino, Deepa Handu, Kellene Isom, Amanda Lynch, Diane DellaValle

    Obesity continues to be a major public health crisis, both nationally and globally. Metabolic and bariatric surgery has been proven to be a safe and effective treatment for this multifactorial chronic disease. However, inconsistent and varied results in bariatric nutrition literature have prevented the implementation of standardized guidelines. The purpose of this Evidence Analysis Library systematic review is to provide an evidence-based summary of nutrition-related practices in bariatric surgery. The systematic review methodology of the Academy of Nutrition and Dietetics was applied. A total of 27 research studies were included, analyzed, and assessed for risk of bias by trained evidence analysts. The literature included in the systematic review was published from 2003 to 2015. Evaluation of the literature resulted in the development of five graded conclusion statements. Limited research demonstrates that registered dietitian nutritionists play a role in improving weight loss outcomes after bariatric surgery; further research is needed to understand the role of registered dietitian nutritionists in changing behaviors after bariatric surgery. Bariatric surgery results in significant reductions in resting metabolic rate and postoperative energy intake. There is no significant relationship between macronutrient distribution and postoperative weight loss. The graded conclusion statements provide registered dietitian nutritionists who practice in the field of bariatric nutrition with more insight and evidence that can guide and support their recommendations.

    更新日期:2018-11-02
  • Association of Dietary Nitrate Intake with the 15-Year Incidence of Age-Related Macular Degeneration
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-10-17
    Bamini Gopinath, Gerald Liew, Annette Kifley, Joshua R. Lewis, Catherine Bondonno, Nichole Joachim, Jonathan M. Hodgson, Paul Mitchell

    Background Dietary nitrate, found predominantly in green leafy vegetables and beetroot, is a precursor of nitric oxide. Under- or overproduction of nitric oxide is implicated in the etiology of several eye diseases. However, the potential influence of dietary nitrate intake on age-related macular degeneration (AMD) risk has not been assessed. Objective To investigate the temporal association between dietary nitrate intake (from both vegetable and nonvegetable sources) and the 15-year incidence of AMD, independent of potential confounders. Design A longitudinal cohort study conducted from 1992-1994 to 2007-2009. Participants/setting The Blue Mountains Eye Study is a population-based study of adults aged 49+ at baseline, from a region west of Sydney, Australia. At baseline, 2,856 participants with complete dietary data and AMD information were examined, and of these, 2,037 participants were re-examined 15 years later and thus included in incidence analysis. Main outcomes measured Incidence of AMD (main outcome) was assessed from retinal photographs. Dietary intake was assessed using a semiquantitative food-frequency questionnaire. Nitrate intake from vegetables and nonvegetable sources was calculated by use of a validated comprehensive database. Results After adjusting for age, sex, smoking, energy intake, fish consumption, and AMD risk alleles (complement factor H and age-related maculopathy susceptibility-2 single nucleotide polymorphisms), participants in the third quartile compared with those in the first quartile (reference group) of total nitrate and total vegetable nitrate intake had reduced risk of incident early AMD: odds ratio (OR) 0.61 (95% CI 0.41 to 0.90) and OR 0.65 (95% CI 0.44 to 0.96), respectively. Significant associations were not observed between the fourth vs first quartile of total nitrate and vegetable nitrate intake with incident early AMD: OR 0.74 (95% CI 0.51 to 1.08) and OR 0.69 (95% CI 0.47 to 1.00), respectively. Nonsignificant associations were also observed with 15-year incidence of late AMD and total nonvegetable nitrate intake. Conclusions These novel findings could have important implications, if the association between total nitrate intake and vegetable nitrate intake and 15-year incidence of early AMD is confirmed in other observational or intervention studies.

    更新日期:2018-10-17
  • Does Providing Assistance to Children and Adolescents Increase Repeatability and Plausibility of Self-Reporting Using a Web-Based Dietary Recall Instrument?
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-10-17
    Rossella Murtas, Vittorio Krogh, Timm Intemann, Lauren Lissner, Gabriele Eiben, Dénes Molnár, Luis A. Moreno, Alfonso Siani, Michael Tornaritis, Toomas Veidebaum, Artur Mazur, Katarzyna Dereń, Maike Wolters, Wolfgang Ahrens, Valeria Pala,

    Background It is important to find ways to minimize errors when children self-report food consumption. Objective The objective of this study was to investigate whether assistance given to children completing a self-administered 24-hour dietary recall instrument called SACANA (Self-Administered Child, Adolescent and Adult Nutrition Assessment) increased the repeatability and plausibility of energy intake (EI) estimates. Participants/setting The study was conducted between October 2013 and March 2016 in a convenience sample of 395 children, aged 8 to 17 years, from eight European countries participating in the I.Family study. Design SACANA was used to recall the previous day’s food intake, twice in a day, once with and once without assistance. Main outcome measures The difference in EI between the first and second recalls was the main repeatability measure; the ratio of EI to basal metabolic rate was the plausibility measure. Statistical methods Generalized linear mixed models, adjusted for sex, age, and body mass index z-score, were used to assess whether assistance during the first vs second recall influenced repeatability and plausibility. Results The difference in estimated EI (EI from second recall minus EI from first recall) was significantly lower (P<0.001) in those assisted at first (median=–76 kcal) than those assisted at second recall (median=282 kcal). Modeling showed that EI at assisted first recall was 19% higher (95% CI 1.13 to 1.24) than in assisted second recall. Overall, 60% of recalls had a plausible EI. Modeling to estimate the simultaneous effects of second vs first recall and assistance vs no assistance on plausibility showed that those assisted at first recall had significantly higher odds of a plausible recall than those unassisted (odds ratio 3.64, 95% CI 2.20 to 6.01), with no significant difference in plausibility of second recall compared to the first (odds ratio 1.48, 95% CI 0.92 to 2.35). Conclusions When children are assisted at first recall, the plausibility and repeatability of the later unassisted recall improve. This improvement was evident for all ages. A future, adequately powered study is required to investigate the age range for which assistance is advisable.

    更新日期:2018-10-17
  • Friends and Family: How African-American Adolescents’ Perceptions of Dietary Beliefs and Behaviors of Others Relate to Diet Quality
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-10-15
    Margaret M. Wrobleski, Elizabeth A. Parker, Erin Hager, Kristen M. Hurley, Sarah Oberlander, Brian C. Merry, Maureen M. Black

    Background Adolescents’ dietary intake often fails to meet national dietary guidelines, especially among low-income African-American youth. The dietary habits established in adolescence are likely to continue into adulthood, and a poor-quality diet increases the risk of developing obesity and chronic disease. Based on principles from ecological and social-cognitive behavior change health theories, perceptions of parental beliefs about healthy eating, perceptions of peer eating behaviors, and parental monitoring of what adolescents eat may positively influence adolescent diet quality. Objective The purposes of this study were to determine whether perceived parental beliefs about nutrition, perceived peer eating behaviors, and reported parental monitoring of the adolescent diet were related to African-American adolescent diet quality and whether these relationships were moderated by adolescent age or sex. Design This secondary cross-sectional study used baseline data (2002 to 2004) from an urban community sample of low-income adolescents participating in a health promotion trial. Participants/setting Participants were 216 African-American adolescent-caregiver dyads in Baltimore, MD. Main outcome measures The 2010 Healthy Eating Index was used to estimate adolescent diet quality. Statistical analyses performed Analyses included correlations, t tests, age- and sex-by-perception regression interactions, and multivariate regressions adjusted for body mass index–for-age percentile, caregiver weight status, and caregiver depressive symptoms. Results Higher diet quality scores were related to higher levels of perceived parental and peer support for healthy eating behaviors among adolescents (β=.21; P<0.05; β=.15; P<0.05, respectively) and to caregiver reports of parental monitoring of adolescent dietary behavior (β=1.38, P<0.01). Findings were not moderated by age or sex. Conclusions Consistent with ecological and social-cognitive theories, adolescents look to their friends and family in making healthy food choices. The relationships uncovered by this study describe some of the contextual, interpersonal influences associated with diet quality among low-income, urban African-American adolescents and warrant further exploration in future intervention studies.

    更新日期:2018-10-16
  • Child Food Insecurity Is Associated with Energy Intake among Fourth- and Fifth-Grade Girls
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-10-11
    May Lynn Tan, Barbara Laraia, Kristine A. Madsen, Lauren E. Au, Edward A. Frongillo, Lorrene D. Ritchie

    Background Food insecurity is associated with poor diet and obesity among adult women, but evidence among children is mixed, and few studies have examined differences between boys and girls. Objective This study examined the relationship between self-reported food insecurity and dietary intake among boys and girls. Design Cross-sectional survey data were used from the Children’s PowerPlay! Campaign evaluation. Participants and setting In all, 3,547 fourth- and fifth-grade students (9 to 11 years old) from 44 San Diego-area elementary schools in 2012 completed diary-assisted 24-hour recalls and a questionnaire that included five questions from the Child Food Security Assessment. Main outcome measures Individual dietary components (including total energy, nutrients, and sugar-sweetened beverages), Healthy Eating Index-2010 scores, and meal patterns (such as meal sizes and missed meals) were derived from 24-hour recalls. Statistical analyses Multivariable linear and logistic regression models were used to estimate the relationships between food insecurity and diet characteristics. Results Girls with the highest food insecurity consumed 135 total kilocalories (P<0.005) and 60 snack kilocalories (P<0.05) more per day than girls with no food insecurity. These relationships were absent among boys. Conclusions Food insecurity among girls in grades 4 and 5 was associated with higher energy intake. Findings support the need for further research to better understand the nature of this relationship and its implications for energy balance.

    更新日期:2018-10-11
  • Association of Grocery Expenditure Relative to Thrifty Food Plan Cost with Diet Quality of Women Participating in the Supplemental Nutrition Assistance Program
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-09-28
    Namrata Sanjeevi, Jeanne H. Freeland-Graves

    Background The Supplemental Nutrition Assistance Program (SNAP) is the largest food assistance program in the United States. Allotment of SNAP benefits is based on the Thrifty Food Plan (TFP), which is designed to achieve a nutritious diet at a minimal cost. Although low-income households do not meet the TFP cost for total groceries, the impact on diet quality is not known. Objective The objective of this research is to determine the relationship of TFP-adjusted total grocery and SNAP-related expenditures with diet quality of women participating in SNAP. Design In this observational study, participants were administered a demographics questionnaire, food frequency questionnaire, and United States adult food security module. Participants were also instructed to save grocery receipts for 1 month. Total and SNAP-related grocery expenditures and TFP cost for each household were determined. The Healthy Eating Index-2010 was used as a measure of diet quality. Participants/setting A total of 217 women from low-income housing and neighborhood centers in central Texas were enrolled from January through December 2015. Eligibility criteria included participation in SNAP; age 18 to 50 years; and Hispanic, non-Hispanic black, or non-Hispanic white race/ethnicity. Fifty-eight women were lost during follow-up. Data from 15 participants were excluded as a result of reporting of implausible caloric intakes or incomplete collection of receipts, thereby resulting in a final sample of 144. Main outcome measures Food group and nutrient intake and diet quality were the main outcome measures of the study. Statistical analysis Multiple linear regression analyses determined the association of TFP-adjusted total grocery and SNAP benefit expenditure with food group intake and diet quality. Independent-samples t test and one-way analysis of variance were used to determine differences in ratio of spending to TFP cost by demographic characteristics. Results The mean ratio of total grocery expenditure to TFP cost was 0.74. Total and SNAP benefit expenditures relative to TFP cost were positively related to fruit and vegetable intake (P<0.01) and diet quality (P<0.05). Ratio of grocery spending to TFP costs did not differ based on food security status. Conclusions The results of this study indicate inadequate grocery spending among SNAP households relative to recommended TFP cost, which in turn was associated with poorer diet quality in women.

    更新日期:2018-09-28
  • Change in an Urban Food Environment: Storefront Sources of Food/Drink Increasing Over Time and Not Limited to Food Stores and Restaurants
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-09-15
    Sean C. Lucan, Andrew R. Maroko, Achint N. Patel, Ilirjan Gjonbalaj, Courtney Abrams, Stephanie Rettig, Brian Elbel, Clyde B. Schechter

    Background Local food environments include food stores (eg, supermarkets, grocery stores, bakeries) and restaurants. However, the extent to which other storefront businesses offer food/drink is not well described, nor is the extent to which food/drink availability through a full range of storefront businesses might change over time. Objectives This study aimed to assess food/drink availability from a full range of storefront businesses and the change over time and to consider implications for food-environment research. Design Investigators compared direct observations from 2010 and 2015. Participants/setting Included were all storefront businesses offering foods/drinks on 153 street segments in the Bronx, NY. Main outcome measures The main outcome was change between 2010 and 2015 as determined by matches between businesses. Matches could be strict (businesses with the same name on the same street segment in both years) or lenient (similar businesses on the same street segment in both years). Investigators categorized businesses as general grocers, specialty food stores, restaurants, or other storefront businesses (eg, barber shops/beauty salons, clothing outlets, hardware stores, laundromats, and newsstands). Statistical analyses performed Investigators quantified change, specifically calculating how often businesses in 2015 were present in 2010 and vice versa. Results Strict matches for businesses in 2015 present in 2010 ranged from 29% to 52%, depending on business category; lenient matches ranged from 43% to 72%. Strict matches for businesses in 2010 present in 2015 ranged from 34% to 63%; lenient matches ranged from 72% to 83%. In 2015 compared with 2010, on 22% more of the sampled street segments, 30% more businesses were offering food/drink: 66 vs 46 general grocers, 22 vs 19 specialty food stores, 99 vs 99 restaurants, 98 vs 56 other storefront businesses. Conclusions Over 5 years, an urban food environment changed substantially, even by lenient standards, particularly among “other storefront businesses” and in the direction of markedly greater food availability (more businesses offering food on more streets). Failure to consider a full range of food/drink sources and change in food/drink sources could result in erroneous food-environment conclusions.

    更新日期:2018-09-17
  • Diabetes Self-Management Education and Medical Nutrition Therapy: A Multisite Study Documenting the Efficacy of Registered Dietitian Nutritionist Interventions in the Management of Glycemic Control and Diabetic Dyslipidemia through Retrospective Chart Review
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-09-13
    Patricia Z. Marincic, Maria V. Salazar, Amie Hardin, Susan Scott, Shirley X. Fan, Philippe R. Gaillard, Christopher Wyatt, Laura Watson, Pamela Green, Pam Glover, Molly Hand

    Background Diabetes self-management education (DSME) and medical nutrition therapy (MNT) improve glycemic control and reduce risk of chronic comorbid disease. Objective Document outcomes for patients with type 2 diabetes (T2D) completing DSME and MNT through American Diabetes Association–recognized programs. Design Descriptive, retrospective chart review. Participants/setting Four random samples of 100 records of patients with T2D completing DSME and MNT at each of four regional centers in Alabama, June 2013 to 2014, were chosen for review; after exclusions, 392 records were retained. Outcome measures Weight, body mass index (BMI), hemoglobin A1c (HbA1c), total cholesterol, low-density lipoprotein, high-density lipoproteins (HDL), triglycerides (TG), and TG-to-HDL ratio. Analysis Mixed-model analysis of variance was used to determine differences between continuous variables. McNemar test was used to assess frequency of patients reaching glycemic targets. Paired t tests were used to determine significance of lipid parameters. Results Significant reductions were observed at end of program and 1 year in weight (2.67±5.54 kg, P<0.001; 2.25±5.45 kg, P=0.001), BMI (0.93±1.91, P<0.001; 0.76±1.93, P=0.001), and HbA1c (1.82%±2.23%, P<0.001; 1.22%±2.15%, P<0.001). Patients managed by diet alone had a mean baseline HbA1c of 6.95% and exhibited a 0.8% reduction in HbA1c (P<0.001) at end of program. Those managed with diet plus drug therapy had a baseline HbA1c of 9% and exhibited a 2.09% reduction in HbA1c (P<0.001). Following DSME and MNT, 62% of patients reached glycemic targets (HcA1c≤7%), as compared with 32% at baseline (P<0.001). Significant reductions in TG were observed from baseline (162±74 mg/dL [4.19±1.91 mmol/L]) to follow-up (109±36 mg/dL [2.82±0.92 mmol/L]) (P<0.001). HDL increased from baseline (45±13 mg/dL [1.16±0.34 mmol/L]) to follow-up (48±11 mg/dL [1.24±0.28 mmol/L]) (P=0.05). The TG-to-HDL ratio improved from a baseline of 4.07±2.41 to 2.48±1.26 at follow-up (P<0.001). Conclusions Reductions were observed in weight, BMI, HbA1c, TG, and TG-to-HDL ratio. Improved patient outcomes were achieved in the clinical setting and support universal coverage to increase patient access to DSME and MNT.

    更新日期:2018-09-13
  • The Impact of 1 Year of Healthier School Food Policies on Students’ Diets During and Outside of the School Day
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-09-10
    Juliana F.W. Cohen, Mary T. Gorski Findling, Lindsay Rosenfeld, Lauren Smith, Eric B. Rimm, Jessica A. Hoffman

    Background In 2012, Massachusetts implemented both the updated national school meal standards and comprehensive competitive food/beverage standards that closely align with current national requirements for school snacks. Objectives This study examines the impact of these combined standards on school meal and snack food selections, as well as food choices outside of school. In addition, this study examines the impact of these standards on nutrients consumed. Design The NOURISH (Nutrition Opportunities to Understand Reforms Involving Student Health) Study was an observational cohort study conducted among students from spring 2012 to spring 2013. Participants/setting One hundred sixty students in 12 middle schools and high schools in Massachusetts completed two 24-hour recalls before (spring 2012) and after implementation (spring 2013) of the updated standards. Main outcome measures Changes in school meals, competitive food, and after-school snack selection, as well as nutrients consumed outside of school were examined. Statistical analyses performed Logistic regression and mixed-model analysis of variance were used to examine food selection and consumption. Results After implementation, 13.6% more students chose a school meal (70.1% vs 56.5%; P=0.02). There were no differences in competitive food purchases but a significant decrease in the number of after-school unhealthy snacks consumed (0.69 [standard error=0.08] vs 1.02 [standard error=0.10]; P=0.009). During the entire day, students consumed, on average, 22 fewer grams of sugar daily after implementation compared with before implementation (86 g vs 108 g; P=0.002). Conclusions With the reduction in the number of unhealthy school snacks, significantly more students selected school meals. Students did not compensate for lack of unhealthy snacks in school by increased consumption of unhealthy snacks outside of school. This provides important new evidence that both national school meal and snack policies may improve daily diet quality and should remain strong.

    更新日期:2018-09-11
  • Dietary Intervention to Increase Fruit and Vegetable Consumption in Breastfeeding Women: A Pilot Randomized Trial Measuring Inflammatory Markers in Breast Milk
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-09-10
    Angela R. Essa, Eva P. Browne, Elizabeth C. Punska, Katelyn Perkins, Emily Boudreau, Hilary Wiggins, Douglas L. Anderton, Lindiwe Sibeko, Susan R. Sturgeon, Kathleen F. Arcaro

    Background Diets rich in fruits and vegetables (F/V) can reduce the inflammatory profile of circulating cytokines and potentially decrease the risk of breast cancer. However, the extent to which a diet rich in F/V alters cytokine levels in breast tissue remains largely unknown. Breast milk provides a means of assessing concentrations of secreted cytokines in the breast microenvironment and is a potential tool for studying the effects of diet on inflammation in breast tissue and breast cancer risk. Objective The aim of this pilot randomized trial was to test the feasibility of increasing F/V intake in breastfeeding women and of measuring changes in markers of inflammation in breast milk. Design and intervention Participants randomized to the intervention (n=5) were provided weekly boxes of F/V, along with dietary counseling, to increase consumption of F/V to 8 to 10 daily servings for 12 consecutive weeks. Controls (n=5) were directed to the US Department of Agriculture’s “ChooseMyPlate” diet for pregnancy and breastfeeding. Participants/setting Ten breastfeeding women consuming fewer than five servings of F/V per day, as estimated by the National Institutes of Health “All-Day” Fruit and Vegetable Screener (F/V Screener), were recruited through flyers and a lactation consultant between February and May 2016 in the Western Massachusetts area. Main outcome measures Baseline demographic and F/V intake data were collected during enrollment. At week 1 and week 13 (final) home visits, participants provided milk samples and anthropometric measurements were recorded. Participants completed F/V screeners at baseline and at study end. Adiponectin, leptin, C-reactive protein, and 11 additional cytokines were measured in breast milk collected at weeks 1 and 13. Statistical analyses F/V consumption at baseline and after the final visit, and between controls and intervention groups, was compared with dependent and independent t tests, respectively. Differences between cytokine levels at weeks 1 and 13 were assessed with a mixed-effects repeated-measures model. Results All women in the intervention increased F/V intake and were consuming more servings than controls by week 13; daily serving of F/V at baseline and final visit: controls=1.6 and 2.0, diet=2.6 and 9.9. Most cytokines were detected in the majority of milk samples: 12 were detected in 90% to 100% of samples, one was detected in 75% of samples, and one was detected in 7.5% of samples; coefficients of variation were below 14% for 11 of the cytokines. Conclusions These preliminary findings indicate that it is feasible to significantly increase F/V intake in breastfeeding women and provide support for conducting a larger diet intervention study in breastfeeding women, in which longer-term benefits of the intervention are assessed.

    更新日期:2018-09-11
  • Grocery Stores Are Not Associated with More Healthful Food for Participants in the Supplemental Nutrition Assistance Program
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-09-01
    Allison M. Lacko, Barry M. Popkin, Lindsey Smith Taillie

    Background Despite interventions to improve the nutrition of grocery store purchases, also referred to as at-home (AH) foods, by participants in the Supplemental Nutrition Program (SNAP), little is known about what proportion of participants’ intake is from AH foods and how the dietary quality of AH food compares with participants’ away-from-home (AFH) food. Although recent research indicates SNAP participants have dietary quality that is slightly worse than that of income-eligible nonparticipants, it is unknown whether this is attributable to AH or AFH consumption. Objective The objective of this study is to examine differences in self-reported dietary intake by food source for SNAP participants compared with income-eligible nonparticipants using 2011-2014 data from the National Health and Nutrition Examination Survey (NHANES). Design This study included data from the NHANES, a cross-sectional, nationally representative survey of the United States population. Study participants This study included 2,523 adults with low incomes (≤130% of the federal poverty level) in NHANES (2011-2014). Main outcome measures Self-reported intake of calories, solid fats, added sugars, and servings of nonstarchy vegetables, whole fruits, and whole grains was assessed by food source in SNAP participants and income-eligible nonparticipants. Statistical analysis Multivariate linear regression was used for each outcome, controlling for relevant sociodemographic characteristics. Data were stratified by food source, including grocery stores, sit-down restaurants, and fast food. Results SNAP participants had a higher intake of solid fats and added sugar from AH foods than nonparticipants. Added sugar from AH food accounted for 15.3% of total calories consumed by SNAP participants, compared with 11.8% for nonparticipants (P<0.001). SNAP participants consumed fewer calories from sit-down restaurants, but both groups consumed similar amounts of calories from fast food. Consumption of nonstarchy vegetables, whole fruits, and whole grains was low for both groups. Conclusions SNAP participants had poorer diet quality from consumption of AH food than did nonparticipants. Future research should focus on interventions to improve the healthfulness of grocery store purchases as a mechanism to improve dietary quality of SNAP participants.

    更新日期:2018-09-03
  • Food Insecurity Is Associated with Body Dissatisfaction among Children in California
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-09-01
    Emily A. Altman, Lorrene D. Ritchie, Edward A. Frongillo, Kristine A. Madsen

    Background Food insecurity affects 13 million children in the United States. Body dissatisfaction is also prevalent, affecting up to 46% of children. Both food insecurity and body dissatisfaction are associated with poor health outcomes, and both are associated with body weight and racial/ethnic disparities. The association between food insecurity and body dissatisfaction among children has not been examined. Objective The purpose of this study was twofold: to examine, in a sample of children in grades 4 through 8, the relationship of child food insecurity with body dissatisfaction and to gain an understanding of the interactive roles of body mass index (BMI), race/ethnicity, and sex in the relationship between food insecurity and body dissatisfaction. Design This was a cross-sectional study. Participants/setting This study examined data obtained from 14,768 children in grades 4 through 8 from 54 public schools in California between 2014 and 2016. Main outcome measures The primary outcome of interest was body dissatisfaction (five items converted to a binary indicator), and the exposure of interest was child-reported food insecurity (three items converted to a binary indicator). Subsets of validated questionnaires were used to assess body dissatisfaction and food insecurity. Statistical analyses performed Data were analyzed using multivariable logistic regression, and effect modification was examined by BMI category (underweight, normal, overweight, obese), race/ethnicity, and sex. Results In this large and diverse sample, after adjusting for cofounders, children experiencing food insecurity, in all BMI categories and from all racial/ethnic backgrounds, had higher odds of body dissatisfaction than their food-secure counterparts. The strength of the relationship differed by BMI and race/ethnicity, with the strongest associations observed for African-American children (odds ratio=2.32; P<0.001) and children with a normal children (odds ratio=1.76; P<0.001). Conclusions Experiencing food insecurity was associated with greater body dissatisfaction, with the magnitude of the association modified by BMI and race/ethnicity.

    更新日期:2018-09-01
  • Association between Vitamin D Status and Premenstrual Symptoms
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-09-01
    Alicia C. Jarosz, Ahmed El-Sohemy

    Background Premenstrual symptoms are experienced by up to 95% of women, and few treatments are available. Previous studies suggest that 25-hydroxyvitamin D (25(OH)D) may be associated with the severity of premenstrual symptoms, but the findings have been inconclusive. Objective The objective of this study was to determine whether vitamin D status is associated with the severity of individual premenstrual symptoms. Design/participants Cross-sectional analysis of 998 women aged 20 to 29 years recruited at the University of Toronto campus from 2004 through 2010. Main outcome measures Participants provided data on their premenstrual symptoms in a premenstrual symptom questionnaire. Fasting overnight blood samples were collected, and plasma 25(OH)D was measured. Participants with plasma 25(OH)D concentrations <20 ng/mL were considered to have inadequate vitamin D status, and those with ≥20 ng/mL, adequate vitamin D status. Statistical analyses performed Multinomial logistic regressions were used to calculate the odds ratio (OR) and 95% confidence interval for the associations between vitamin D status and the severity of 15 premenstrual symptoms. Adjustments were made for age, body mass index, ethnicity/race, physical activity, hormonal contraceptive use, season of blood draw, use of analgesics, and calcium intake. Results Compared with participants with adequate vitamin D status, those with inadequate vitamin D status had an increased risk (odds ratio [OR]; 95% CI) of experiencing the following mild symptoms: confusion (OR=1.72; 95% CI, 1.14 to 2.59) and desire to be alone (OR=1.47; 95% CI; 1.03 to 2.10), as well as the following moderate/severe symptoms: cramps (OR=1.50; 95% CI, 1.02 to 2.21), fatigue (OR=1.51; 95% CI, 1.04 to 2.21), anxiety (OR=1.63; 95% CI, 1.02 to 2.63), confusion (OR=2.23; 95% CI, 1.18 to 4.21), and sexual desire (OR=1.65; 95% CI, 1.09 to 2.51). Vitamin D status was not associated with other premenstrual symptoms (acne, bloating, mood swings, increased appetite, headache, clumsiness, insomnia, depression, or nausea). Conclusion Findings suggest that inadequate vitamin D status may be associated with increased severity of some, but not all, premenstrual symptoms.

    更新日期:2018-09-01
  • Planning Well-Balanced Vegetarian Diets in Infants, Children, and Adolescents: The VegPlate Junior
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-08-31
    Luciana Baroni, Silvia Goggi, Maurizio Battino
    更新日期:2018-08-31
  • Examining the Feasibility of Healthy Minimum Stocking Standards for Small Food Stores
    J. Acad. Nutr. Diet. (IF 4.021) 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

    ObjectiveIn 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.DesignWe 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.ResultsStore 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.ConclusionsIn 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.

    更新日期:2018-07-14
  • Reliability and Validity of Digital Imagery Methodology for Measuring Starting Portions and Plate Waste from School Salad Bars
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-04-12
    Melanie K. Bean, Hollie A. Raynor, Laura M. Thornton, Alexandra Sova, Mary Dunne Stewart, Suzanne E. Mazzeo

    BackgroundScientifically sound methods for investigating dietary consumption patterns from self-serve salad bars are needed to inform school policies and programs.ObjectiveTo 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/methodsIn 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 analysesIntraclass 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.ResultsInterrater 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.ConclusionsThis 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.

    更新日期:2018-07-14
  • A Higher-Calorie Refeeding Protocol Does Not Increase Adverse Outcomes in Adult Patients with Eating Disorders
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-04-12
    Kylie Matthews, Jan Hill, Shane Jeffrey, Susan Patterson, Amanda Davis, Warren Ward, Michelle Palmer, Sandra Capra

    BackgroundPatients 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.ObjectiveTo 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.DesignThis was a retrospective pre-test–post-test study.Participants/settingOne 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 measuresDifferences in prevalence of electrolyte disturbances, hypoglycemia, edema, and RFS diagnoses were examined.Statistical analysis performedχ2 tests, Kruskal-Wallis H test, analysis of variance, and independent t tests were used to compare data between the two protocols.ResultsDescriptors 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).ConclusionsA 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.

    更新日期:2018-07-14
  • 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 4.021) 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

    BackgroundIn 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.ObjectiveThe 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).DesignThe study was a secondary analysis of data from a randomized controlled trial.Participants/settingA 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 measuresAt baseline and at 3 and 6 months, body composition was determined by DXA and STM.Statistical analyses performedStatistical 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.ResultsThirty 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.ConclusionsDespite 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.

    更新日期:2018-07-14
  • Understanding Customers: The Jobs to Be Done Theory Applied in the Context of a Rural Food Pantry
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-04-30
    J. Mitchell Vaterlaus, Natalie Martineau Cottle, Emily Vaterlaus Patten, Robyn Gibbons

    BackgroundFood 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.ObjectiveThis 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.DesignA 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.ResultsThe key themes that emerged were the customer in context, customers’ food relief needs, connecting with customers, and barriers to utilization.ConclusionsThe 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.

    更新日期:2018-07-14
  • New Equations to Predict Body Fat in Asian-Chinese Adults Using Age, Height, Skinfold Thickness, and Waist Circumference
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-05-08
    Christiani Jeyakumar Henry, Shalini D/O Ponnalagu, Xinyan Bi, Sze-Yen Tan

    BackgroundAdiposity 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.ObjectiveThe aim of the study was to develop body fat prediction equations for Asian-Chinese adults using easily attainable anthropometric measurements.DesignPrediction 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/settingHealthy 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 measuresData 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 performedSex-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.ResultsThe 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).ConclusionsSex-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.

    更新日期:2018-05-09
  • <img height="20" border="0" style="vertical-align:bottom" width="23" alt="Online Extra" title="Online Extra" src="http://origin-ars.els-cdn.com/content/image/1-s2.0-S2212267218302569-oextra_o.gif">Trends in Dietary Sodium from Food Sources in Australian Children and Adolescents from 2007 to 2011/12
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-05-03
    Carley A. Grimes, Ewa A. Szymlek-Gay, Caryl A. Nowson

    BackgroundIn 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.ObjectiveTo compare sodium consumption of Australian children aged 2 to 16 years from 2007 to 2011/12.DesignCross-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/settingA 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 measuresMean 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 preformedStatistical 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.ResultsDietary 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.ConclusionAlthough 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.

    更新日期:2018-05-04
  • <img height="20" border="0" style="vertical-align:bottom" width="23" alt="Online Extra" title="Online Extra" src="http://origin-ars.els-cdn.com/content/image/1-s2.0-S2212267218301461-oextra_o.gif">Managing Complexity in Evidence Analysis: A Worked Example in Pediatric Weight Management
    J. Acad. Nutr. Diet. (IF 4.021) 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.

    更新日期:2018-05-02
  • Adjustment Factors Can Improve Estimates of Food Group Intake Assessed Using a Short Dietary Assessment Instrument
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-05-01
    Gilly A. Hendrie, Megan A. Rebuli, Rebecca K. Golley, Manny Noakes

    BackgroundMethods to address misreporting associated with short dietary assessment instruments are needed.ObjectiveOur 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.DesignValidation 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/settingThree 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 measuresFood group intake (in servings) was measured.Statistical analyses performedDescriptive and inferential statistical analyses were conducted.ResultsDirect 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.ConclusionsAdjustment factors can improve estimates of food group intake assessed using a short dietary assessment instrument for some but not all food groups.

    更新日期:2018-05-01
  • Measuring Micro-Level Effects of a New Supermarket: Do Residents Within 0.5 Mile Have Improved Dietary Behaviors?
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2017-08-08
    Stephanie Rogus, Jessica Athens, Jonathan Cantor, Brian Elbel

    BackgroundLocal 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.ObjectiveOur 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.DesignThis 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/settingWe 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.InterventionA 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 measuresThe 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 performedA difference-in-difference analysis was performed, controlling for age, education, marital status, income, sex, race, and ethnicity.ResultsResidents 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.ConclusionsGiven 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).

    更新日期:2018-04-26
  • 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 4.021) Pub Date : 2017-08-17
    Anat Gesser-Edelsburg, Yael Birman

    BackgroundLifestyle 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.ObjectiveOur aim was to ascertain the impact of the physical environment on the dynamics and communication between dietitian and patient based on perceptions of dietitians.DesignWe conducted qualitative constructivist phenomenological research.ParticipantsIn-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.ResultsMost 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.ConclusionsChanges 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.

    更新日期:2018-04-26
  • 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 4.021) Pub Date : 2017-09-01
    Miranda R. Blake, Anna Peeters, Emily Lancsar, Tara Boelsen-Robinson, Kirstan Corben, Christopher E. Stevenson, Claire Palermo, Kathryn Backholer

    BackgroundLimited 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.ObjectiveOur 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.DesignA convergent parallel mixed methods design complemented sales data (122 weeks pre-intervention, 17 weeks during intervention) with stakeholder interviews and customer surveys.Participants/settingElectronic 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).InterventionBeverages 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 measuresChanges in beverage volume, item sales, and revenue during the intervention were compared with predicted sales.Statistical analysesSales data were analyzed using time series segmented regression while controlling for pre-intervention trends, autocorrelation in sales data, and seasonal fluctuations.ResultsBeverage 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.ConclusionsA 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.

    更新日期:2018-04-26
  • Child Feeding Style and Dietary Outcomes in a Cohort of Latino Farmworker Families
    J. Acad. Nutr. Diet. (IF 4.021) 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

    BackgroundThe 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.ObjectiveThis 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.DesignThis 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/settingEligible 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 measuresFeeding 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 performedExploratory 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.ResultsFour 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).ConclusionsHigh PC feeding along with high CC feeding is associated with improved diet quality and weight outcomes for children in the study.

    更新日期:2018-04-26
  • 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 4.021) Pub Date : 2018-04-22
    Jennifer Burris, James M. Shikany, William Rietkerk, Kathleen Woolf

    BackgroundA 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.ObjectiveThis 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.DesignThis 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.ParticipantsSixty-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 measuresThe primary outcomes were biochemical factors of acne and insulin resistance with dietary intake as a secondary outcome.Statistical analysesIndependent sample t tests assessed changes in biochemical factors associated with acne, dietary intake, and body composition pre- and postintervention, comparing the two dietary interventions.ResultsIGF-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.ConclusionsIn 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.

    更新日期:2018-04-25
  • <img height="20" border="0" style="vertical-align:bottom" width="23" alt="Online Extra" title="Online Extra" src="http://origin-ars.els-cdn.com/content/image/1-s2.0-S221226721830159X-oextra_o.gif">Inuit Country Food Diet Pattern Is Associated with Lower Risk of Coronary Heart Disease
    J. Acad. Nutr. Diet. (IF 4.021) Pub Date : 2018-04-21
    Xue Feng Hu, Tiff-Annie Kenny, Hing Man Chan

    BackgroundInuit 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.ObjectiveTo identify contemporary dietary patterns among Inuit and investigate their association with cardiovascular disease outcomes.DesignThis was an association study in a cross-sectional population health and nutrition survey.ParticipantsThe 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 measuresOutcomes measured included the prevalence of coronary heart disease, myocardial infarction, stroke, hyperlipidemia, and hypertension.Statistical analyses performedPrincipal 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.ResultsThree 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.ConclusionsA diet featuring high food variety, high fish intake, and low sugar intake was negatively associated with the prevalence of cardiovascular outcomes among Inuit.

    更新日期:2018-04-25
  • <img height="20" border="0" style="vertical-align:bottom" width="23" alt="Online Extra" title="Online Extra" src="http://origin-ars.els-cdn.com/content/image/1-s2.0-S221226721830145X-oextra_o.gif">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 4.021) 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

    BackgroundEarlier scales on mindful eating do not measure mindful eating independent from emotional or external eating, or mindful eating in common situations.ObjectiveThe 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.DesignA cross-sectional ancillary study within the Longitudinal Aging Study Amsterdam was conducted between fall 2014 and spring 2015.Participants/settingParticipants were 1,227 Dutch adults aged 55 years and older from the Longitudinal Aging Study Amsterdam.Main outcome measureA selection of 20 items from existing instruments was used to design an initial version of the MEBS.Statistical analyses performedThe 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.ResultsTwo 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.ConclusionsThe 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.

    更新日期:2018-04-11
Some contents have been Reproduced with permission of the American Chemical Society.
Some contents have been Reproduced by permission of The Royal Society of Chemistry.
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