当前期刊: Journal of the Academy of Nutrition and Dietetics Go to current issue    加入关注   
显示样式:        排序: 导出
  • Phenolic Acid Subclasses, Individual Compounds, and Breast Cancer Risk in a Mediterranean Cohort: The SUN Project
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2020-01-22
    Andrea Romanos-Nanclares; Cristina Sánchez-Quesada; Itziar Gardeazábal; Miguel Ángel Martínez-González; Alfredo Gea; Estefanía Toledo

    Background Biological and epidemiological evidence supports an inverse association of phenolic acids with obesity-related chronic diseases. However, no previous study has prospectively evaluated the relationship between subclasses and individual compounds of phenolic acids and the risk of postmenopausal breast cancer, one of the most important and prevalent obesity-related cancer sites. Objective This study examined associations between subclasses of phenolic acids, including hydroxycinnamic and hydroxybenzoic acids intake, and risk of breast cancer. Design The Seguimiento Universidad de Navarra (SUN) Project is a dynamic, permanently open prospective cohort which started in 1999. Participants/setting Participants were 10,812 middle-aged women. All of them were university graduates. Main outcome measures Usual diet was assessed at baseline and after 10 years of follow-up with a 136-item food frequency questionnaire. Phenolic acid intake was calculated by matching food consumption with the Phenol-Explorer database on phenolic acids content of each reported food item. Statistical analysis performed Participants were classified according to tertiles of subclasses or individual compounds of phenolic acids. Cox regression models were fitted to estimate multivariable-adjusted hazard ratios and 95% CIs for breast cancer incidence. Results Over an average of 11.8 years of follow-up, 101 incident cases of breast cancer were confirmed. After multivariable adjustment, an inverse association between hydroxycinnamic acids intake and breast cancer was observed (hazard ratio third tertile vs first tertile 0.37, 95% CI 0.16 to 0.85; P for trend=0.029) among postmenopausal women. Specifically, chlorogenic acids (3-, 4-, and 5- caffeoylquinic acids) showed the strongest inverse association (hazard ratio third tertile vs first tertile 0.33, 95% CI 0.14 to 0.78; P for trend=0.012). Conclusions A higher intake of hydroxycinnamic acids, especially from chlorogenic acids—present in coffee, fruits, and vegetables—was associated with a lower incidence of breast cancer among postmenopausal women. Future observational studies are needed to corroborate these results.

  • The Influence of the New US Nutrition Facts Label on Consumer Perceptions and Understanding of Added Sugars: A Randomized Controlled Experiment
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2020-01-22
    Neha Khandpur; Eric B. Rimm; Alyssa J. Moran

    Background and objectives This study assessed the effects of the new Nutrition Facts label (NFL) compared with the current NFL on consumer purchase intentions and understanding of added sugars, and differences by educational attainment. Design Randomized controlled online experiment. Participants/setting Final study sample of 1,156 US adults, oversampling participants with low education. Intervention All participants were exposed to a control condition (images of bread, 100% juice, yogurt, and canned fruit with no NFL) and then randomized to one of two label conditions: the current NFL with information on total sugars only or the new NFL with information on added sugars. Participants responded to the same set of questions in the control and the label conditions while viewing products that displayed one of the two NFLs. Main outcome measures Differences in scores averaged across all products for understanding of added sugars (proportion of correctly answered multiple-choice questions) and purchase intentions (5-point Likert scale ranging from extremely likely to extremely unlikely). Statistical analyses performed One-way analysis of variance was used to test for differences between NFLs. Results Compared with the current NFL, participants in the new NFL arm had better understanding of added sugars content (P<0.01). Although no significant differences were seen for purchase intentions overall, there were differences for individual products. Participants in the new NFL arm were more likely to purchase the juice (P<0.01) and less likely to buy the bread (P<0.01) compared with participants in the current NFL arm. There were no differences by educational attainment. Conclusions Participants were better able to locate and extract added sugars information when viewing the new NFL compared with the current NFL. The new NFL may increase intent to purchase products low in added sugars but high in refined carbohydrates—an unintended consequence that warrants further study.

  • Resistant Starch Content in Foods Commonly Consumed in the United States: A Narrative Review
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2020-01-22
    Mindy A. Patterson; Madhura Maiya; Maria L. Stewart

    Resistant starch (RS; types 1 to 5) cannot be digested in the small intestine and thus enters the colon intact, with some types capable of being fermented by gut microbes. As a fiber, types 1, 2, 3, and 5 are found naturally in foods, while types 2, 3, and 4 can be added to foods as a functional ingredient. This narrative review identifies RS content in whole foods commonly consumed in the United States. Scientific databases (n=3) were searched by two independent researchers. Ninety-four peer-reviewed articles published between 1982 and September 2018 were selected in which the RS was quantified and the food preparation method before analysis was suitable for consumption. The RS from each food item was adjusted for moisture if the RS value was provided as percent dry weight. Each food item was entered into a database according to food category, where the weighted mean±weighted standard deviation was calculated. The range of RS values and overall sample size for each food category were identified. Breads, breakfast cereals, snack foods, bananas and plantains, grains, pasta, rice, legumes, and potatoes contain RS. Foods that have been cooked then chilled have higher RS than cooked foods. Foods with higher amylose concentrations have higher RS than native varieties. The data from this database will serve as a resource for health practitioners to educate and support patients and clients interested in increasing their intake of RS-rich foods and for researchers to formulate dietary interventions with RS foods and examine associated health outcomes.

  • Understanding the Psychological Distress of Food Insecurity: A Qualitative Study of Children’s Experiences and Related Coping Strategies
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2020-01-17
    Cindy W. Leung; Anita L. Stewart; Eduardo T. Portela-Parra; Nancy E. Adler; Barbara A. Laraia; Elissa S. Epel

    Background Food insecurity, a condition of inadequate household food availability, affects 15.7% of US households with children. Food insecurity is generally believed to affect the quantity and quality of food consumed. However, an understudied but important aspect of the experience of food insecurity is psychological distress. Objective To critically explore the psychological distress associated with children’s food insecurity using children’s own reports of their experiences. Design In-depth qualitative interviews conducted with children to better understand the psychological distress associated with food insecurity. Participants/setting Sixty children (aged 7 to 14 years) were recruited from the San Francisco Bay Area. Children were eligible in the case that they spoke English fluently and their parent reported any experience of household food insecurity during the past year. Results Children discussed six themes related to the psychological distress associated with food insecurity: worrying about not having enough food, worrying about their parents’ well-being, anger and frustration about not having enough food, embarrassment about their family’s food situation, strain on the family’s dynamics due to food insecurity, and sadness over not having enough food. After describing their experiences, children described strategies they employed to tolerate or cope with food insecurity, including distracting from or using their imagination to cope with food insecurity, increasing tolerance of their family’s food situation, and appreciating their parents for providing food and resources. Conclusions Food insecurity contributes to children’s psychological distress. Given the known effects of chronic stress in childhood, the psychological distress of food insecurity may represent an important mechanism by which food insecurity adversely influences children’s growth and development and deserves investigation in future studies.

  • Nutrition Assessment, Interventions, and Monitoring for Patients with Celiac Disease: An Evidence Analysis Center Scoping Review
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2020-01-15
    Feon W. Cheng; Deepa Handu

    The objectives of this scoping review were to identify and characterize studies examining nutrition assessment, interventions, and measures to monitor gluten-free diet (GFD) adherence/compliance in patients with celiac disease (CD). An electronic literature search of four databases (Cochrane Database for systematic reviews, CINAHL, Embase, and Ovid MEDLINE) was conducted to identify articles examining nutrition care in CD individuals. Except for narrative review, grey literature, and case study/report, all types of peer-reviewed articles published between January 2007 and August 2018 were eligible. There were a total of 10,823 records; 10,368 were excluded during the first round of screening due to irrelevancy and/or duplication. Of the 455 full-text articles that were assessed, 292 met the criteria and were included. Most of the studies were observational studies (n=212), followed by experimental trials (n=50), evidence-based practice guideline (EBPG)/report/statement (n=16), and systematic review (SR) (n=14). Nine original studies examined assessment, focusing mainly on different tools/ways to assess GFD adherence. The majority of the included original articles (n=235) were in the nutrition intervention category with GFD, oats, and prebiotics/probiotics as the top-three most studied interventions. There were eight SRs on GFD and five on oats. One SR and 21 original studies investigated the effectiveness of different measures to monitor GFD adherence/compliance. Although recent CD EBPGs were identified, different methods with varying levels of rigor, in terms of literature search and assessment of evidence strength, were used. Based on this scoping review, interventions focused on gluten-free diet and oats have been significantly covered by either SRs or EBPGs. Studies related to prebiotics/probiotics and education program/counseling focused interventions, as well as assessment, in CD patients have increased in recent years. Thus, it might be beneficial to conduct SRs/EBPGs focused on these topics to guide practitioners.

  • Updated Nutrition Standards Have Significantly Improved the Nutritional Quality of School Lunches and Breakfasts
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2020-01-13
    Elizabeth C. Gearan; Mary Kay Fox

    Background Implementation of updated nutrition standards for school meals began during school year (SY) 2012-2013. The standards were designed to improve the nutritional quality of the meals and their consistency with the Dietary Guidelines for Americans. Objective To assess the nutritional quality of school lunches and breakfasts after the updated standards were in place and compare it with the nutritional quality of the meals before the updated standards. Design School menu data were used from two cross-sectional, nationally representative studies of schools participating in the National School Lunch Program during SY 2014-2015 (School Nutrition and Meal Cost Study) and SY 2009-2010 (fourth School Nutrition Dietary Assessment Study). Participants/setting The analysis used 1 week of school menu data from 1,206 schools at lunch and 1,110 schools at breakfast for SY 2014-2015, and 884 schools at lunch and 802 schools at breakfast for SY 2009-2010. Outcome measures Healthy Eating Index 2010 scores were estimated. Statistical analyses Descriptive analyses were conducted to estimate mean Healthy Eating Index 2010 total and component scores for school meals. Scores are expressed as a percentage of maximum possible scores. Two-tailed t tests were used to assess differences in scores before and after updated standards were in place. Results Total Healthy Eating Index 2010 scores for school lunches and breakfasts increased significantly after the updated standards. Between SY 2009-2010 and SY 2014-2015, the total score for school lunches increased from 58% of the maximum score to 82%, and the total score for school breakfasts increased from 50% to 71% (P<0.05). For both meals, component scores increased by more than 20 percentage points for whole grains, refined grains, and empty calories, as well as for greens and beans for lunches and whole fruit and sodium for breakfasts. Conclusions The updated nutrition standards for schools meals significantly improved the nutritional quality of the meals and their consistency with the Dietary Guidelines for Americans.

  • Do Parents Perceive That Organized Activities Interfere with Family Meals? Associations between Parent Perceptions and Aspects of the Household Eating Environment
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2020-01-08
    Nicole Larson; Jayne A. Fulkerson; Jerica M. Berge; Marla E. Eisenberg; Dianne Neumark-Sztainer

    Background Research has related child participation in organized activities to health and academic benefits; however, participation may interfere with family meals. Objective Examine whether parents perceive child participation in organized activities to interfere with family meals and how perceptions are related to the household eating environment. Design A cross-sectional analysis was completed using survey data collected in 2015-2016 as part of the Project EAT (Eating and Activity in Teens and Young Adults) cohort study. Participants Survey participants were originally recruited in Minneapolis–St Paul schools in 1998-1999. The analytic subsample of parents (one per household, n=389, 69% female, 31% nonwhite race, mean age=31) had one or more children involved in an organized activity. Approximately 33% of households included a child aged 2 to 5 and no older child; two thirds of households included school-aged children (6 to 18 years). Main outcome measures Parents reported family meal frequency, family meal scheduling difficulties, frequency of at-home meal preparation, and their own intake of fast food, fruit, and vegetables. Statistical analyses performed Analyses compared household environment characteristics reported by parents who perceived low interference between organized activities and family meals to characteristics reported by parents who perceived moderate to high interference from at least one form of activity. Regression models included a dichotomous indicator of interference as the independent variable and were adjusted for parental and household characteristics. Results Among parents with children at any age, moderate to high interference was associated with lower family meal frequency, greater difficulty scheduling family meals, and more fast-food intake (all P≤0.01). The perception of moderate to high interference was more common among parents who reported involvement in both sport and nonsport activities (P<0.001) and those with a school-aged child (P<0.001) vs those with only preschool-aged children. Conclusions Follow-up research, including qualitative studies, is needed to identify the specific aspects of child participation in organized activities (eg, scheduled time of day) that may interfere with family meals.

  • Cost-Effectiveness of Three Doses of a Behavioral Intervention to Prevent or Delay Type 2 Diabetes in Rural Areas
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-12-30
    Tiffany A. Radcliff; Murray J. Côté; Melanie D. Whittington; Michael J. Daniels; Linda B. Bobroff; David M. Janicke; Michael G. Perri

    Background Rural Americans have higher prevalence of obesity and type 2 diabetes (T2D) than urban populations and more limited access to behavioral programs to promote healthy lifestyle habits. Descriptive evidence from the Rural Lifestyle Intervention Treatment Effectiveness trial delivered through local cooperative extension service offices in rural areas previously identified that behavioral modification with both nutrition education and coaching resulted in a lower program delivery cost per kilogram of weight loss maintained at 2-years compared with an education-only comparator intervention. Objective This analysis extended earlier Rural Lifestyle Intervention Treatment Effectiveness trial research regarding weight loss outcomes to assess whether nutrition education with behavioral coaching delivered through cooperative extension service offices is cost-effective relative to nutrition education only in reducing T2D cases in rural areas. Design A cost-utility analysis was conducted. Participants/setting Trial participants (n=317) from June 2008 through June 2014 were adults residing in rural Florida counties with a baseline body mass index between 30 and 45, but otherwise identified as healthy. Intervention Trial participants were randomly assigned to low, moderate, or high doses of behavioral coaching with nutrition education (ie, 16, 32, or 48 sessions over 24 months) or a comparator intervention that included 16 sessions of nutrition education without coaching. Participant glycated hemoglobin level was measured at baseline and the end of the trial to assess T2D status. Main outcome measures T2D categories by treatment arm were used to estimate participants’ expected annual health care expenditures and expected health-related utility measured as quality adjusted life years (ie, QALYs) over a 5-year time horizon. Discounted incremental costs and QALYs were used to calculate incremental cost-effectiveness ratios for each behavioral coaching intervention dose relative to the education-only comparator. Statistical analyses performed Using a third-party payer perspective, Markov transition matrices were used to model participant transitions between T2D states. Replications of the individual participant behavior were conducted using Monte Carlo simulation. Results All three doses of the behavioral coaching intervention had lower expected total costs and higher estimated QALYs than the education-only comparator. The moderate dose behavioral coaching intervention was associated with higher estimated QALYs but was costlier than the low dose; the moderate dose was favored over the low dose with willingness to pay thresholds over $107,895/QALY. The low dose behavioral coaching intervention was otherwise favored. Conclusions Because most rural Americans live in counties with cooperative extension service offices, nutrition education with behavioral coaching programs similar to those delivered through this trial may be effective and efficient in preventing or delaying T2D-associated consequences of obesity for rural adults.

  • Advertising Placement in Digital Game Design Influences Children’s Choices of Advertised Snacks: A Randomized Trial
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-12-28
    Rachel Smith; Bridget Kelly; Heather Yeatman; Christopher Moore; Louise Baur; Lesley King; Emma Boyland; Kathy Chapman; Clare Hughes; Adrian Bauman

    Background Children are inhabitants of a media-rich environment rife in extensive, sophisticated, and persistent techniques that are used to market unhealthy food. Exposure is known to influence children’s attitudes, choices, and consumption, yet further research is required to explore the influence of contemporary techniques within online games. Objective To explore the influence of modern advertising on children’s attitudes, choices, and consumption, techniques (ie, banner advertising, advergame, and rewarded video advertising) were used to promote an unfamiliar confectionery brand within an online game. Design A between-subjects randomized experimental study. Participants/setting Children (aged 7 to 12 years [n=156]) were recruited in New South Wales, Australia, between September and November 2017. Intervention Children were required to play a 4-minute online game, complete some questionnaires, and choose one snack to consume afterward. Children were randomly assigned to one of four conditions: a control group with no advertising, and three experimental conditions that promoted an unfamiliar confectionery brand via a banner advertisement, advergame, or rewarded video advertisement. Main outcome measures Questionnaires included the assessment of attitudes to the test brand before and after the game, enjoyment of the game, and children’s awareness of advertising. Food choice was recorded and food consumption was measured by weighing the snack in grams, which was translated into kilocalories. Statistical analyses performed Statistical tests included analyses of variance, Kruskal-Wallis test, and χ2 test. Results Attitudes toward the perception of fun (P=0.06) and taste (P=0.21) of the test brand were not influenced by condition. Children who were exposed to the rewarded video advertising chose the test brand significantly more than children in the other three conditions (P<0.002). Condition did not influence overall energy intake measured in grams (P=0.78) or kilocalories (P=0.46). Conclusions Children’s choice of the test brand was significantly influenced by the rewarded video advertising condition (compared with control, banner advertising, and advergame conditions). This technique is prevalent across online and application games that children play yet the effects of using rewarded video advertising to promote food brands have not been explored from a public health perspective. This study contributes to the understanding of modern strategies used to market unhealthy foods to children.

  • Nutritional Deficiencies in Patients with Severe Obesity before Bariatric Surgery: What Should Be the Focus During the Preoperative Assessment?
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-12-28
    Tair Ben-Porat; Ram Weiss; Shiri Sherf-Dagan; Nour Nabulsi; Achinoam Maayani; Abed Khalaileh; Salayme Abed; Ronit Brodie; Rivki Harari; Yoav Mintz; Alon J. Pikarsky; Ram Elazary

    Background Nutritional deficiencies are a well-recognized long-term complication following bariatric surgery. The presence of preoperative deficiencies has been shown to be predictive of postoperative deficiencies. Objective The aim of the study was to investigate the prevalence of micronutrient deficiency in a large sample of patients with severe obesity preoperatively, and to determine whether such deficiencies may be related to patient’s sex, body mass index, or ethnic subgroup. Design A cross-sectional study of data collected at the time of the preoperative evaluation. Participants/setting Data were collected during the preoperative evaluation of 872 bariatric surgery candidates in a university hospital in Israel between 2011 and 2018. The patients were 72.9% women, with a mean age of 37.9±12.1 years and mean body mass index of 42.4±4.7 Main outcome measures Nutritional deficiencies according to blood assays. Data on anthropometrics, comorbidities, and demographic characteristics was also collected. Statistical analyses Baseline differences between patient subgroups were analyzed using independent-samples t test, analysis of variance, or χ2 test. Results Deficiencies of vitamin D, iron, folate, vitamin B-12, elevated parathyroid hormone and low transferrin saturation were present in 75.2%, 42.6%, 28.5%, 8.5%, 35.5%, and 70% of patients, respectively. Nutritional deficiencies were significantly more common among women compared with men for iron (45.9% vs 33.5%; P=0.002), low transferrin saturation (77.7% vs 44.6%; P<0.001), vitamin D (77.5% vs 69.2%; P=0.019) and elevated parathyroid hormone level (39.5% vs 22.9%; P=0.002). Iron, transferrin saturation, and vitamin D deficiencies were more prevalent in Arab patients compared with Jewish patients: 59.6% vs 36%; P<0.001, 80.2% vs 62.8%; P=0.003, and 85.1% vs 71.6%; P<0.001, respectively. Vitamin D and iron deficiency were more common among higher body mass index subgroups (P=0.004 and P=0.040, respectively). Conclusions The results indicate a high prevalence of nutritional deficiencies, mainly of iron and vitamin D in bariatric surgery candidates. Patients at higher risk for nutritional deficiencies include those with higher body mass index, women, and Arabs.

  • Associations between Red Meat Intake and Sleep Parameters in Patients with Obstructive Sleep Apnea
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-12-28
    Ioanna Kechribari; Meropi D. Kontogianni; Michael Georgoulis; Kallirroi Lamprou; Irene Mourati; Emmanuel Vagiakis; Nikos Yiannakouris

    Background Although lifestyle changes have been investigated as a therapeutic choice in regard to obstructive sleep apnea (OSA) severity, data exploring associations between apnea and hypopnea indices and dietary habits are scarce. Objective The aim was to investigate possible relationships between apnea and hypopnea indices and red meat intake in a cohort of Greek patients with mild or moderate to severe OSA evaluated by polysomnography. Design This is a cross-sectional study. Data were collected from November 2014 through July 2018. Participants/setting The sample consisted of 243 patients (21 to 70 years old) who were recently diagnosed with OSA, by overnight attended polysomnography in the Sleep Disorders Center of “Evangelismos” Hospital, Athens Medical School (Greece). The patients included were free of other chronic diseases and had not changed their dietary habits for at least 6 months before evaluation. Main outcome measures Information on participants’ dietary intake, food group consumption, physical activity, smoking, sleep habits, and anthropometric measures were collected. Dietary intake was evaluated by food frequency questionnaire and 24-hour dietary recalls. Adherence to the Mediterranean diet was also evaluated using the Mediterranean Diet Score. Statistical analyses performed General linear models were used to examine the relation between red meat intake and sleep parameters, while adjusting for potential confounders. Multiple logistic regression was also applied to estimate the association between red meat intake and the likelihood of severe OSA. Results Higher intakes of total red meat and unprocessed red meat were associated with higher values of apnea and hypopnea indices, after controlling for age, sex, waist circumference, socioeconomic parameters, smoking, physical activity, adequacy of nighttime sleep, and intake of foods or food components in the Mediterranean diet other than red meat (P trend for increasing quartiles of intake ≤0.02). Compared with patients in the lowest quartile of energy-adjusted total red meat intake (≤0.59 servings/day per 1,000 kcal), patients in the highest quartile (≥1.18 servings/day) had three times higher likelihood of having severe OSA (odds ratio: 3.09, 95% CI: 1.17 to 8.14). Conclusions The results provide evidence of a positive association between total red meat and unprocessed red meat intake with apnea or hypopnea indices and suggest that red meat consumption is associated with OSA severity.

  • Assessing the Concurrent Validity and Interrater Reliability of Patient-Led Screening Using the Malnutrition Screening Tool in the Ambulatory Cancer Care Outpatient Setting
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-12-28
    Alexandra Di Bella; Emilie Croisier; Claire Blake; Anita Pelecanos; Judy Bauer; Teresa Brown

    Background The prevalence of malnutrition in cancer patients is reported as high as 65%; however, malnutrition screening is often substandard. The Malnutrition Screening Tool (MST) has been validated for use by health care professionals to detect at-risk patients; however, there is a gap in the literature regarding validation of patient-led MST screening. Objective The aim of the study was to assess the concurrent validity of patient-led MST against the Subjective Global Assessment (SGA) and the interrater reliability of patient-led MST against dietitian-led MST in patients attending ambulatory cancer care services for chemotherapy or supportive treatments. Design/participants A single-site diagnostic accuracy study of 201 patients between May and June 2017 attending the ambulatory cancer care setting at an Australian metropolitan tertiary hospital in Queensland. Main outcome measurements The primary outcome measures were concurrent validity and interrater reliability of MST scores as determined by patients (patient-MST), dietitians (dietitian-MST), and SGA as completed by the dietitian. Statistical analysis Concurrent validity of patient-led MST scores against the SGA was determined using specificity, sensitivity, positive predictive values, and negative predictive values. Interrater reliability of patient-MST and dietitian-MST was assessed using κ coefficient. Results The ability of the patient-led MST scores (0 to 1 vs 2 to 5) to indicate nutrition status was found to have a sensitivity of 94% (95% CI 81% to 99%), a specificity of 86% (95% CI 79% to 91%), and an area under the receiver operating characteristic curve of 0.93 (95% CI 0.89 to 0.96). The positive predictive value was 59% (95% CI 45% to 71%), and the negative predictive value was 99% (95% CI 95% to 100%). A weighted κ of 0.83 (95% CI 0.82 to 0.87) between patient-MST and dietitian-MST was found. Conclusion Patient-led MST screening is a reliable and valid measure that can accurately identify ambulatory cancer care patients as at risk or not at risk of malnutrition.

  • Dietary Intakes of Vitamin B-2 (Riboflavin), Vitamin B-6, and Vitamin B-12 and Ovarian Cycle Function among Premenopausal Women
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-12-23
    Keewan Kim; James L. Mills; Kara A. Michels; Ellen N. Chaljub; Jean Wactawski-Wende; Torie C. Plowden; Sunni L. Mumford

    Background Riboflavin, vitamin B-6, and vitamin B-12 are key players in one-carbon metabolism as enzymatic cofactors, and deficiency of these nutrients may influence reproductive outcomes possibly through affecting reproductive hormones. Objective The goal was to investigate associations between dietary intakes of riboflavin, vitamin B-6, and vitamin B-12, and menstrual function among premenopausal women. Design This was a secondary analysis of a prospective cohort study conducted at the University at Buffalo during 2005 to 2007. Participants/setting Participants were 259 healthy, regularly menstruating women (aged 18 to 44 years) with self-reported menstrual cycles between 21 and 35 days, who were not trying to conceive, and who had not used hormonal contraception during the past 3 months. Main outcome measures Intakes of B vitamins were assessed via 24-hour dietary recalls four times per menstrual cycle for two cycles. Serum reproductive hormones and plasma homocysteine were measured eight and three times, respectively, per cycle for two cycles. Anovulatory cycles were determined by progesterone concentrations ≤5 ng/mL (15.9 nmol/L) and no observed serum luteinizing hormone peak during the mid or late luteal phase visit. Statistical analysis Weighted linear mixed regressions were used to evaluate associations between cycle-averaged B vitamin intakes and hormones and homocysteine, and generalized linear regressions for associations with anovulation. Models were adjusted for age, race, body mass index, physical activity, alternate Mediterranean diet score, intakes of total energy, protein, fiber, and folate, and percentage of energy intake from fat. Results Higher intakes of riboflavin (per 0.1 mg increase in intake) were inversely correlated with estradiol (−0.87%, 95% CI −1.67 to −0.06) and homocysteine levels (−0.61%, 95% CI −1.10 to −0.12). Higher vitamin B-6 intakes were suggestive of higher follicle-stimulating hormone, although the results were not statistically significant (0.63% difference, 95% CI −0.03 to 1.29, per 0.1 mg increase in intake; P=0.06). Small increases in testosterone and decreases in homocysteine were found with vitamin B-12 intake. No associations were observed between intake of B vitamins and a risk of sporadic anovulation. Conclusions Higher intakes of riboflavin were associated with a small decrease in serum estradiol among healthy, regularly menstruating women. Higher intakes of riboflavin and vitamin B-12 were associated with lower plasma homocysteine concentrations. Overall, riboflavin, vitamin B-6, and vitamin B-12 that are one-carbon nutrients do not appear to influence the ovarian cycle among premenopausal women.

  • Adult Malnutrition (Undernutrition) Screening: An Evidence Analysis Center Systematic Review
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-12-19
    Annalynn Skipper; Anne Coltman; Jennifer Tomesko; Pam Charney; Judith Porcari; Tami A. Piemonte; Deepa Handu; Feon W. Cheng

    Background Malnutrition screening relies on quick and easy-to-use tools that require minimal training of users. Valid and reliable tools should avoid under-referral of adults with a malnutrition diagnosis or over-referral of those without a malnutrition diagnosis to dietitians. Objective Our aim was to conduct a systematic review of adult malnutrition screening tools for validity, agreement, and reliability, and to determine the costs of the malnutrition screening procedure. Methods Following a structured process, a comprehensive search using PubMed, MEDLINE, EMBASE, and CINAHL was conducted for relevant research published between 1997 and 2017 that examined the validity, agreement, reliability, and costs of nutrition screening tools. Results Sixty-nine studies met the inclusion criteria. The Malnutrition Screening Tool exhibited moderate validity, agreement, and reliability based on Grade I (Good/Strong) evidence. The evidence supporting the conclusions for the remaining tools was Fair (Grade II). The Malnutrition Universal Screening Tool exhibited high validity and moderate agreement and reliability. The Mini Nutritional Assessment–Short Form exhibited moderate validity and reliability and low agreement. The Short Nutritional Assessment Questionnaire and the Nutrition Risk Screening 2002 exhibited moderate validity and reliability and the Mini Nutritional Assessment–Short Form Body Mass Index exhibited high validity and moderate agreement. However, these last three tools were missing reliability or agreement data. Limited data were available to evaluate malnutrition screening costs. Conclusions This review provides an analysis of validity, agreement, and reliability of tools to screen adults for malnutrition, regardless of their age, medical history, or location. No tools were found with high validity, reliability, and strong supportive evidence. Tools most often achieved moderate validity, agreement, and reliability, and had large variations in individual results. The minimum validity and reliability of tools to screen adults for malnutrition should be established to shape future research. Cost data for the screening process should be obtained and examined.

  • Position of the Academy of Nutrition and Dietetics: Malnutrition (Undernutrition) Screening Tools for All Adults
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-12-19
    Annalynn Skipper; Anne Coltman; Jennifer Tomesko; Pamela Charney; Judith Porcari; Tami A. Piemonte; Deepa Handu; Feon W. Cheng

    It is the position of the Academy of Nutrition and Dietetics that, based upon current evidence, the Malnutrition Screening Tool should be used to screen adults for malnutrition (undernutrition) regardless of their age, medical history, or setting. Malnutrition (undernutrition) screening is a simple process intended to quickly recognize individuals who may have a malnutrition diagnosis. While numerous malnutrition screening tools are in use, their levels of validity, agreement, reliability, and generalizability vary. The Academy of Nutrition and Dietetics reviewed the body of evidence supporting malnutrition screening tools and determined a single tool for identifying adults in all settings who may have malnutrition, regardless of their age or medical history. The Nutrition Screening for Adults Workgroup conducted a systematic review of the most robust evidence to promote using the highest-quality malnutrition screening tool available.

  • Evaluation of a Quantitative Food Frequency Questionnaire for 5-Year-Old Children in an Asian Population
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-12-19
    Ray Sugianto; Mei Jun Chan; Shu Fang Wong; Lynette Pei-Chi Shek; Kok Hian Tan; Yap Seng Chong; Keith M. Godfrey; Bee Choo Tai; Mary Foong-Fong Chong

    Background Food frequency questionnaires (FFQs) are often used to assess dietary intakes due to their ability to assess intake over extended periods, their low respondent burden, and their cost-effectiveness. A quantitative FFQ that includes locally appropriate food items for 5-year-old children in a multiethnic Asian population was developed, but its validity has not previously been evaluated. Objective To evaluate the relative validity of a newly developed FFQ as a dietary assessment tool for 5-year-old children in a multiethnic Asian population. Design The 112 –food item FFQ was administered by trained interviewers to caregivers of children. Frequency of food items consumed in the previous month and portion size information were collected. The FFQs were evaluated against 3-day nonweighed diet records (DRs) completed by caregivers. Participants/setting The dietary data of 361 children aged 5 years from the Growing Up in Singapore Towards Healthy Outcomes mother-offspring cohort were collected in 2015-2016. Main outcome measures Nutrients of interest included energy, macronutrients, fiber, cholesterol, vitamin A, beta carotene, calcium, and iron, calculated from the FFQs and DRs. Statistical analyses performed Nutrient intakes according to FFQs in relation to DRs were assessed using Pearson’s correlation, Lin’s concordance, Bland-Altman plots, quintile joint classification, and Cohen’s κ statistics. Results The highest energy-adjusted correlation (Pearson’s r=0.71) and concordance (Lin’s concordance=0.69) were observed for calcium. Fiber, saturated fat, polyunsaturated fatty acids (PUFA), cholesterol, and iron also showed correlation coefficients and concordance of at least 0.40. Bland-Altman plots suggested no substantial bias across ranges of intakes for the nutrients with correlations and concordance of 0.40 or above. Quintiles joint classification showed substantial agreement for calcium (κ=0.66), and moderate agreement for iron, fiber, saturated fat, polyunsaturated fat, and beta carotene (κ=0.59, 0.54, 0.49, 0.44, 0.43, respectively). Conclusions The newly developed FFQ is in reasonable agreement with DR for estimating intakes of calcium, fiber, saturated fat, PUFA, cholesterol, and iron. In addition, the FFQ is able to classify children according to quintiles of nutrient intakes, with moderate to substantial quintile agreements between FFQ and DR for calcium, iron, fiber, saturated fat, PUFA, and beta carotene. To assess the remaining nutrients, DR method is recommended instead of the FFQ.

  • Contributions of Early Care and Education Programs to Diet Quality in Children Aged 3 to 4 Years in Central North Carolina
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-12-09
    Courtney T. Luecking, Stephanie Mazzucca, Amber E. Vaughn, Dianne S. Ward

    Background Parents and early care and education (ECE) are the key influencers of young children’s diets, but there is limited information about how each contribute to children’s overall diet quality. Objective This study aimed to determine what proportion of children’s dietary intake occurs within the ECE setting and whether diet quality is higher at ECE centers and, consequently, on weekdays than weekends. Design This cross-sectional analysis of a larger cluster randomized controlled trial used multiple 24-hour dietary intakes measured through a combination of the Dietary Observation in Child Care protocol and parent-reported food diaries. Participants/setting Participants (N=840) included children aged 3 to 4 years enrolled in ECE centers in central North Carolina for whom 24-hour dietary intake was captured via observation of meals and snacks consumed at ECE and parent-report of all remaining meals and snacks. Data were collected from 2015 to 2016. Main outcome measures Diet quality at ECE and elsewhere was evaluated using the Healthy Eating Index 2015. Statistical analyses performed Mixed-effects models were used to determine differences in mean Healthy Eating Index 2015 component and total scores. Models were adjusted for children’s age and sex and accounted for clustering within ECE centers and families. Results Children consumed approximately 40% of daily energy, nutrients, and food groups at ECE centers. The mean total Healthy Eating Index 2015 score was higher for foods and beverages consumed at ECE centers (58.3±0.6) than elsewhere (52.5±0.6) (P<0.0001). The mean total Healthy Eating Index 2015 score was also higher on weekdays (58.5±0.5) than on weekends (51.3±0.5) (P<0.0001). Conclusions Children consume a majority of dietary intake away from ECE centers. Overall, diet quality is low, but the quality of foods consumed by children at ECE centers is higher than that consumed elsewhere. ECE centers remain an important source of nutrition and further investigation is warranted to identify ways to support both ECE centers and families to provide healthier eating environments.

  • The Association between the 2009 WIC Food Package Change and Early Childhood Obesity Risk Varies by Type of Infant Package Received
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-12-09
    M. Pia Chaparro, May C. Wang, Christopher E. Anderson, Catherine M. Crespi, Shannon E. Whaley

    Background In 2009, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages were updated. WIC-participating children in Los Angeles County receiving the new food package, compared with the old, had lower obesity risk at age 4. Objective To determine if the association between the new WIC food package and obesity varies by type of infant WIC food package received. Design Longitudinal study using administrative data on children participating in WIC in Los Angeles County continuously from birth until age 4. Children were compared across periods: Before (period 1: born 2003-2004), straddling (period 2: born 2005-2008), and after (period 3: born 2009-2011) the food package change. Children were further grouped as Fully Breastfed, Mostly Breastfed, Mostly Formula Fed, and Fully Formula Fed based on the type of food packages received during the first year of life. Participants/setting WIC-participating children in Los Angeles County between 2003 and 2016 (N=116,991). Main outcome measures Weight-for-height z-score growth trajectories from 0 to 4 years and obesity (body mass index-for-age≥95th percentile) at age 4. Statistical analyses performed Children were matched across periods on infant feeding group; age, sex, race or ethnicity, and initial weight status; maternal education and language; and family poverty. Sex-stratified piecewise linear spline mixed models and Poisson regression models were fit to the data. Results No differences across periods were observed for children in the Fully Breastfed group. Boys in the Mostly Breastfed (relative risk [RR]=1.27, 95% CI=1.17 to 1.38), Mostly Formula Fed (RR=1.07, 95% CI=1.02 to 1.13), and Fully Formula Fed (RR=1.13, 95% CI=1.06 to 1.20) groups in period 1 had higher obesity risk than their counterparts in period 3; girls in the Mostly Breastfed group in period 1 had a higher obesity risk than those in period 3 (RR=1.17, 95% CI=1.07 to 1.28). Conclusions The association between the WIC food package change and obesity varied by type of infant food package received, with the strongest associations observed for those who were mostly breastfed.

  • Women’s Experience and Understanding of Food Cravings in Pregnancy: A Qualitative Study in Women Receiving Prenatal Care at the University of North Carolina–Chapel Hill
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-12-06
    Lauren E. Blau, Leah M. Lipsky, Katherine W. Dempster, Miriam H. Eisenberg Colman, Anna Maria Siega-Riz, Myles S. Faith, Tonja R. Nansel

    Background Although the occurrence of food cravings during pregnancy is well established, there is a paucity of qualitative data on pregnant women’s perceptions of and responses to food cravings. This study sought to assess and describe pregnant women’s experiences and behaviors pertaining to food cravings. Methods Eight focus groups were conducted with 68 pregnant women in their second trimester from March 2015 to October 2016. Using a semistructured approach, the facilitator asked women open-ended questions regarding their experience of eating behaviors and food cravings. The content from the focus groups was analyzed using a bottom-up approach based on grounded theory and constant comparison analysis. Results Participants described cravings as urgent, food-specific, and cognitively demanding occurrences that were differentiated from hunger. They described beliefs surrounding the physiological causes of cravings and rationales for satisfying their cravings. Strategies used to manage cravings included environmental modifications to limit proximity and availability of craved foods, cognitive and behavioral strategies like distraction, and acceptance through satisfying the craving. Participants described food cravings as a psychologically salient aspect of their pregnancy, reporting a variety of emotional precursors and reactions surrounding their cravings. Conclusions A better understanding of food cravings may assist with the development of interventions to improve eating behaviors and reduce eating-related distress during pregnancy. Acceptance regarding food cravings was indicated as a way to diffuse pregnancy-related stress. These findings contribute to our understanding of psychological influences on eating behaviors in pregnant women.

  • Evaluating the Validity of a Food Frequency Questionnaire in Comparison with a 7-Day Dietary Record for Measuring Dietary Intake in a Population of Survivors of Colorectal Cancer
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-12-03
    Janna L. Koole, Martijn J.L. Bours, José J.L. Breedveld-Peters, Eline H. van Roekel, Martien C.J. M. van Dongen, Simone J.P. M. Eussen, Moniek van Zutphen, Fränzel J.B. van Duijnhoven, Hendriek C. Boshuizen, Matty P. Weijenberg

    Background Food frequency questionnaires (FFQs) are a commonly used method to assess dietary intake in epidemiological studies. It is important to evaluate the validity of FFQs in the population of interest. Objective To evaluate the validity of an FFQ for measuring dietary intake in survivors of colorectal cancer (CRC), relative to a 7-day dietary record. Design Dietary intake was assessed 1 year after the end of CRC treatment. Participants first completed a 7-day dietary record and 2 weeks later a 253-item FFQ that measured intake in the preceding month. Participants/setting Data were used from a subsample of participants (n=100) enrolled in an ongoing prospective study (EnCoRe study) in the Netherlands, from 2015 to 2018. Main outcome measures Estimated intakes of total energy, 19 nutrients, and 20 food groups as well as scoring adherence to the dietary recommendations of the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) were compared between both dietary assessment methods. Statistical analyses performed Means and standard deviations, Spearman rank correlations corrected for within-person variation and total energy, and κ agreement between quintiles were assessed. Results The median Spearman correlation corrected for within-person variation for nutrients and total energy was 0.60. Correlations >0.50 were found for 15 of 19 nutrients, with highest agreement for vitamin B-12 (0.74), polysaccharides (0.75), and alcohol (0.91). On average, 73% (range=60% to 84%) of participants were classified into the exact same or adjacent nutrient quintile. The median Spearman correlation corrected for within-person variation for food groups was 0.62. Correlations >0.50 were found for 17 of 20 food groups, with highest agreement for cereals and cereal products (0.96), fish (0.96), and potatoes (0.99). The Spearman correlation between total scores of the WCRF/AICR dietary recommendations was 0.53. Conclusions Relative to a 7-day dietary record, the validity of an FFQ for measuring dietary intake among survivors of CRC appeared moderate to good for most nutrients and food groups.

  • The Influence of Diet Interventions Using Whole, Plant Food on the Gut Microbiome: A Narrative Review
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-11-29
    Holly J. Willis, Joanne L. Slavin

    Dietary intake is a key determinant of gastrointestinal microbiota composition. Studies have considered the relationship between gut microbiota and dietary patterns. It is likely that certain plant foods that contain fiber and other bioactive matter may be more likely to drive microbial changes than others; however, study design and other factors can make interpretation of the literature difficult. Fifteen well-controlled, well-defined diet interventions published between 2008 and 2018 using whole, plant foods were evaluated for their influence on gut microbiota. There was limited effect on microbial diversity across studies and modest microbial changes were noted in 10 of 15 studies. More research is needed before specific plant foods can be recommended to improve gut microbiota and ultimately health. Methodologic considerations for future diet and microbiome studies are discussed. Additional research to better understand how specific whole, plant foods influence microbe composition, functionality, and metabolite production is needed, as are mechanistic studies linking diet-induced gut microbe changes to health.

  • Effectiveness of Tailored Dietary Counseling in Treating Malnourished Outpatients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-11-27
    Ha Thanh Nguyen, Toby G. Pavey, Peter F. Collins, Nhung Viet Nguyen, Tuong Duy Pham, Danielle Gallegos

    Background Malnutrition in patients with chronic obstructive pulmonary disease (COPD) is common and associated with poor prognosis. Nutrition interventions are necessary, but there is a lack of evidence regarding the effectiveness of tailored nutrition advice. Objective This study investigated whether tailored nutrition counseling could improve dietary intake, nutritional status, functional outcomes, and health-related quality of life (QoL) of malnourished outpatients with COPD. Design We conducted a randomized controlled trial in which participants were randomly assigned to either the intervention group (IG) or the control group (CG). Participants/setting One hundred and twenty malnourished outpatients with COPD participated in the study between May and November 2017 at the National Lung Hospital, Hanoi, Vietnam. Intervention The IG received tailored nutrition counseling once per month for 3 months based on a specifically developed written nutrition resource for COPD. The CG received the same educational resource at baseline without any discussion. Main outcome measures The main outcome measures were energy and protein intakes, body weight change, nutritional status (Subjective Global Assessment score), muscle strength, and QoL. Statistical analyses Differences between groups before and after the intervention were assessed using two-way repeated measures analysis of variance. Generalized estimating equation modeling was used to investigate the differences between groups over time. Results At baseline, there were no significant differences in outcomes of interest between the two groups. After 3 months of intervention, time–intervention interactions for energy intake, protein intake, and body weight change were significant (945 kcal/day, 95% CI 792 to 1,099 kcal/day, P<0.001; 50.0 g protein/day, 95% CI 43.9 to 56.1 g protein/day, P<0.001; and 1.0 kg, 95% CI 0.5 to 1.5 kg, P<0.001, respectively). Subjective Global Assessment scores improved in the IG and worsened in the CG. Significant improvements were found in inspiratory muscle strength in the IG (5.4 cmH2O, 95% CI 2.3 to 8.6 cmH2O, P=0.001) and significant decreases in handgrip strength were found in the CG after 3 months of the intervention (1.4 kg, 95% CI 0.4 to 2.4 kg, P=0.007). There was a significant interaction effect for all QoL scores (analysis of variance two-way repeated, P≤0.003). The IG also significantly improved all QoL scores from baseline to 3 months (P<0.004). Conclusions Tailored nutritional counseling has the potential to improve dietary intakes, nutritional status, functional outcomes, and QoL in malnourished outpatients with COPD.

  • The Contribution of Snacking to Overall Diet Intake among an Ethnically and Racially Diverse Population of Boys and Girls
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-11-25
    Katie A. Loth, Allan Tate, Amanda Trofholz, Jennifer Orlet Fisher, Dianne Neumark-Sztainer, Jerica M. Berge

    Background Children in low-income and minority populations are at risk for poor dietary quality. At least one-third of the calories consumed by children are eaten between meals (ie, snacks). The contribution of snacking to diet quality among children is poorly understood. Objective The current study examined associations between snacking and children’s diet quality along with differences across ethnicity or race, sex, and weight status. Design Cross-sectional data came from Phase I of the Family Matters Study, an observational study. Participants/setting This study included 150 families with children aged 5 to 7 years old from six ethnic or racial groups (n=25 from each: African American, Hispanic, Hmong, Native American, Somali, non-Hispanic white); data were collected in Minneapolis–Saint Paul, MN in 2017-2018. Main outcome measures Total daily energy (kilocalories), overall diet quality using the Healthy Eating Index (HEI-2010), and food group intakes (eg, fruit, vegetables, refined grains, sugar-sweetened beverages [SSB]) were assessed using three 24-hour dietary recalls. Statistical analyses performed Conditional fixed effects estimators (within-child variation) were used in regression analyses to characterize the relationship between daily snacking and dietary intake relative to dietary intake at all other daily meal occasions. Mean (±standard deviation) overall dietary intake including all meals and snacks was compared with mean (±standard deviation) intake of meals only. Results Among boys, snacking was found to contribute positively to HEI-2010 scores (HEI-2010=57.6, HEI-2010 without snacks=55.0; effect size [ES]=0.28, P=0.03). Snacking was an important source of fruit (ES=0.71) and dairy (ES=0.53), but also contributed to children’s consumption of refined grains (ES=0.68) and SSB (ES=0.31). Very few vegetables were consumed as snacks. Furthermore, snacks contributed more to the overall diet quality (HEI-2010) of Native American (ES=0.30) and Somali (ES=0.35) youth as compared with youth from other ethnic or racial backgrounds. Conclusions Findings suggest that snacks have the potential to improve diet quality in children. Future research should examine influences on children’s food choices at snack times and barriers to serving more healthful foods as snacks that are faced by ethnically or racially diverse families.

  • Establishing Validity and Cross-Context Equivalence of Measures and Indicators
    J. Acad. Nutr. Diet. (IF 4.141) 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.

  • Reported Knowledge of Typical Daily Calorie Requirements: Relationship to Demographic Characteristics in US Adults
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-07-08
    Robin A. McKinnon, Taiye Oladipo, Martine S. Ferguson, Olivia E. Jones, Maya E. Maroto, Beverly Wolpert

    Background US obesity rates are at historically high levels, increasing the risk of negative health and economic outcomes at individual and population levels. Findings from earlier studies indicate that many consumers lack a clear understanding of calorie needs, potentially affecting their ability to manage caloric intake. Objective Our aim was to determine the knowledge of typical daily calorie needs of US adults by demographic and other characteristics, using a nationally representative sample. Design Data were analyzed from 6,267 respondents to the 2007-2008 and 2009-2010 National Health and Nutrition Examination Survey and its supplemental data source, the Flexible Consumer Behavior Survey, to assess reported knowledge of typical daily calorie requirements and associations with demographic and other characteristics of interest. Statistical analyses performed Logistic regression for complex sample surveys was used to estimate associations between self-reported daily calorie needs for men and women aged 21 years and older and participant characteristics. Results Most respondents accurately reported typical daily calorie needs for a person of their sex, age group, and physical activity level, however, distinct differences emerged between demographic groups. Women, non-Hispanic whites, and those with higher income and education levels were more likely to estimate typical daily calorie needs accurately; men were almost four times more likely than women to indicate a lack of knowledge of daily calorie needs. Conclusions Knowledge of typical daily calorie requirements is a foundational concept of nutrition literacy. Educational efforts to increase awareness, knowledge, and use of calorie information for certain groups may be helpful to refine interventions and ultimately improve public health in the United States.

  • Frequency of Consumption of Whole Fruit, Not Fruit Juice, Is Associated with Reduced Prevalence of Obesity in Korean Adults
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-06-28
    Ahreum Choi, Kyungho Ha, Hyojee Joung, YoonJu Song

    Background Fruit consumption is known to be beneficial to health. However, the health benefits of fruit juice are controversial due to its high sugar content. Objectives To examine the associations of frequency of consumption of whole fruit and fruit juice with obesity and metabolic syndrome. Design This cross-sectional study used data from the 2012-2015 Korea National Health and Nutrition Examination Survey. Participants A total of 10,460 adults (4,082 men and 6,378 women) aged 19 to 64 years were included in the study. Main outcome measures Frequency of consumption of whole fruit and fruit juice was evaluated using a food frequency questionnaire, and dietary sugar intake was calculated using a 24-hour recall. Obesity and abdominal obesity were determined using body mass index and waist circumference, respectively. Metabolic syndrome was defined on the basis of the National Cholesterol Education Program Adult Treatment Panel III. Statistical analyses performed Multiple logistic regression analysis was performed to examine the associations between frequency of whole fruit or fruit juice consumption and obesity and metabolic syndrome abnormalities. Results The percentage of participants who consumed whole fruit daily was 32.6%, whereas 52.3% consumed fruit juice rarely. The average intake of total sugars was 14.9% of total energy, which was within the recommend range (<20% of total energy) for Koreans. Consuming whole fruit ≥1 time/day was associated with reduced prevalence of obesity, abdominal obesity, and elevated blood pressure compared with consuming whole fruit ≤1 time/wk. However, frequency of fruit juice consumption showed no association with obesity, abdominal obesity, and metabolic syndrome. Conclusions Frequency of whole fruit consumption was associated with reduced prevalence of obesity and metabolic syndrome abnormalities among Korean adults with average total sugar intake within the recommended range.

  • Associations between Consumption of Ultra-Processed Foods and Intake of Nutrients Related to Chronic Non-Communicable Diseases in Mexico
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-06-28
    Joaquín A. Marrón-Ponce, Mario Flores, Gustavo Cediel, Carlos Augusto Monteiro, Carolina Batis

    Background Ultra-processed foods are highly palatable and can be consumed anywhere at any time, but typically have a poor nutritional profile. Therefore, their contribution to total energy intake has been proposed as an indicator for studying overall dietary quality. Objective The aim of this study was to investigate the associations between the energy contribution from ultra-processed foods and the intake of nutrients related to chronic non-communicable diseases in Mexico. Design This study used a secondary analysis of cross-sectional data from the 2012 Mexican National Health and Nutrition Survey. Participants/setting This study included participants aged 1 year and older (n=10,087) who had completed a 1-day 24-hour recall. Main outcome measures Intake from added sugar (% kcal), total fat (% kcal), saturated fat (% kcal), protein (% kcal), dietary fiber (g/1,000 kcal), and dietary energy density (kcal/g) were measured. Statistical analysis Multiple linear regression models adjusted for sociodemographic variables were fitted to assess the association between quintiles of energy contribution from ultra-processed foods and nutrient intake. Results Mean reported energy contribution from ultra-processed foods to the Mexican population’s diet ranged from 4.5% kcal in quintile 1 (Q1) to 64.2% kcal in quintile 5 (Q5). An increased energy contribution from ultra-processed foods was positively associated with intake from added sugar (Q1: 7.4% kcal; Q5: 17.5% kcal), total fat (Q1: 30.6% kcal; Q5: 33.5% kcal) and saturated fat (Q1: 9.3% kcal; Q5: 13.2% kcal), as well as dietary energy density (Q1: 1.4 kcal/g; Q5: 2.0 kcal/g) (P≤0.001); and inversely associated with intake from protein (Q1: 15.1% kcal; Q5: 11.9% kcal) and dietary fiber (Q1: 16.0 g/1,000 kcal; Q5: 8.4 g/1,000 kcal) (P≤0.001). Conclusions In the Mexican population, an increased energy contribution from ultra-processed foods was associated with a lower dietary quality with regard to intake of nutrients related to chronic non-communicable diseases. Future research is needed to identify barriers to eating a variety of unprocessed and minimally processed foods for the Mexican population, as well as effective public health strategies and policies to overcome these barriers.

  • Diet Quality among the Brazilian Population and Associated Socioeconomic and Demographic Factors: Analysis from the National Dietary Survey 2008-2009
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-06-24
    Juliana de Paula Matos Souza, Manuela Magela de Lima, Paula Martins Horta

    Background Evaluating diet quality is a way to monitor a population’s adherence to dietary guidelines. Objective To adapt the Healthy Eating Index-2015 (HEI-2015) to the Brazilian population, to evaluate the validity and reliability of the adapted HEI-2015, and to assess diet quality of Brazilian adults as well as socioeconomic and demographic factors associated with diet quality. Design In this cross-sectional study, two dietary records from nonconsecutive days were used to obtain food intake information. The collected socioeconomic and demographic data included sex, age, education, per capita income, and residence area. Participants/setting A representative sample (n=27,760) of the Brazilian adult population participated in the Nutrition Dietary Survey 2008-2009. Main outcome measures Total and component scores for the adapted HEI-2015. The validity and reliability of the index were tested. Statistical analysis performed Mean total and component scores were estimated for the adapted HEI-2015. Also, the proportion of subjects that achieved the maximum score for each component was calculated. Regarding validity and reliability analysis, principal components analysis examined the number of dimensions; Pearson correlations were estimated between total score, components, and energy, and Cronbach’s coefficient α was estimated. Diet quality was compared among socioeconomic and demographic categories. Results The mean total score for the adapted HEI-2015 was 45.7 (95% CI: 45.4 to 46.0). Women had higher diet quality scores (46.4; 95% CI: 46.1 to 46.7) than men (44.9; 95% CI: 44.6 to 45.3). Age, education, and per capita income were directly associated with the adapted HEI-2015 total score. Greater than or equal to 50% of subjects received the maximum adapted HEI-2015 component scores for “total protein foods,” “seafood and plant proteins,” “fatty acids,” and “sodium.” In contrast, less than 30% of subjects received the maximum component scores for “total vegetables,” “dairy,” and “saturated fats.” Higher percentages of women received the maximum component scores for “total fruits,” “whole fruits,” “total vegetables,” “greens,” “dairy,” and “sodium,” whereas higher percentages of men received the maximum component scores for “total protein foods,” “seafood and plant proteins,” “fatty acids,” “added sugars,” and “saturated fats” components. Finally, validity analysis revealed weak correlations between component scores and energy and weak to moderate correlations with total scores; six dimensions were responsible for the total variance in diet quality and the standardized Cronbach’s coefficient α was .65 (unstandardized=.64). Conclusions Brazilian adults have suboptimal diet quality as assessed by the adapted HEI-2015. Diet quality varied by socioeconomic and demographic factors. Results support the validity and the reliability of the index.

  • Using Latent Class Growth Modeling to Examine Longitudinal Patterns of Body Mass Index Change from Adolescence to Adulthood
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-07-10
    Jennifer N. Becnel, Amanda L. Williams

    Background Few studies use longitudinal designs to assess patterns of body mass index (BMI) change from adolescence to adulthood or incorporate severe obesity as a unique subgroup. Objective To examine patterns of BMI trajectories from adolescence to adulthood and identify demographic characteristics associated with each BMI trajectory pattern. Design Height, weight, and demographic characteristics were drawn from Waves I to V of the nationally representative school-based sample of the National Longitudinal Study of Adolescent to Adult Health (Add Health) conducted from 1994 to 2018 (data collection is ongoing). Participants/setting Participants included 3,315 (55.5% female) subjects responding to in-home interviews across all five Waves of Add Health. Main outcome measures BMI at each wave modeled over time. Statistical analyses Latent class growth modeling and logistic regression analysis using population sample weights. Results Five classes of weight patterns best fit the sample. Twenty-nine percent of the sample had an always healthy BMI (class 1) and 34.9% changed from healthy weight to overweight (class 2). Moving from healthy weight to obese comprised 21.8% of the sample (class 3). BMI patterns increasing from overweight to obese (class 4) and from obese to severely obese (class 5) comprised 7.6% and 7.1% of the sample, respectively. Weight change was similar for males and females with some racial or ethnic minority participants more likely to be severely obese in adulthood. Conclusions Results emphasize the importance of tracking weight longitudinally and point to a nationally representative trend of increasing BMI during the transition to adulthood. There was no substantive decreasing trend identified in the sample. Findings highlight the need for effective early and ongoing intervention and prevention strategies and can aid in identification of vulnerable youth who are at the highest risk for moving to problematic weight categories.

  • Knowledge Translation and Evidence-Based Practice: A Qualitative Study on Clinical Dietitians’ Perceptions and Practices in Switzerland
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-07-08
    Ludivine Soguel, Carla Vaucher, Theresa Bengough, Bernard Burnand, Sophie Desroches

    Background Knowledge translation (KT) in health care is essential to promote quality of care and reduce the knowledge-to-practice gap. Little is known about KT among dietitians, and a better understanding of how this process pans out is fundamental to support their clinical practice. Objective To explore clinical dietitians’ perceptions and practices concerning preferences and access to information sources in clinical practice, KT activities, research in nutrition and dietetics, and evidence-based practice (EBP). Design, participants, and setting Eight interviews and two focus groups involving a total of 15 participants were conducted in 2013 among members of the Swiss Association for Registered Dietitians in the French- and German-speaking regions of Switzerland. Analysis performed Thematic analysis drawn from a constructivist grounded theory approach. Results Information from colleagues and experts of the field were favored when facing unfamiliar situations in clinical practice. Critically selecting evidence-based information was considered challenging, but dietitians declared they were at ease to integrate patients’ preferences and values, and their clinical expertise and judgment, in decision making, which are fundamental elements of EBP. A major reported barrier to KT was the perception that time to identify and read scientific literature was not expected during working hours and that instead, this time should be spent in clinical activities with patients. On the other hand, dietitians identified that their frequent involvement in educational activities such as knowledge dissemination or tailoring favored the integration of evidence into practice. Finally, dietitians struggled more to identify evidence-based information about counseling and communication than about biomedical knowledge. Conclusions Dietitians mentioned being involved in each step of the KT process (ie, synthesis, dissemination, exchange, and ethically sound application of knowledge). Barriers and facilitators identified in this study need to be explored in a larger population to develop strategies to facilitate KT and EBP in dietetics practice.

  • Development and Preliminary Evaluation of Chinese Preschoolers’ Caregivers’ Feeding Behavior Scale
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-05-08
    Jing Yuan, Yuhai Zhang, Tong Xu, Hao Zhang, Zhou Lu, Xianjun Yang, Meiqin Hu, Lifen Yu, Lili Yu, Xun Jiang, Lei Shang

    Background Caregivers’ feeding behavior plays a crucial role in the development of overweight and obesity in preschoolers. However, to date, there is no broadly accepted scale or questionnaire for assessing preschoolers’ caregivers’ feeding behavior in China. Objective To develop a scale that can be used to assess preschoolers’ caregivers’ feeding behavior in China and to conduct a preliminary evaluation of the scale’s reliability, validity, and discriminative ability. Design The scale was created through a literature review and qualitative interviews with the target population. Items were reviewed by 50 caregivers of preschoolers and 10 experienced pediatricians, and 95 items were selected to form a draft scale. The draft scale underwent three rounds of investigation, and the results from these evaluations were used to select items that formed the final scale. Participants/setting Three groups of caregivers (n=175, 400, and 912) were sampled and stratified from urban and suburban kindergartens in the cities of Jinan and Xi’an between March 2016 and October 2017 to participate in evaluations of the draft scale. From these caregiver groups, 146, 362, and 768 participants completed valid questionnaires, respectively, which were used in the scale’s evaluation. Primary outcome measures The general demographic data of the participants and scores of each item in the scale were the primary outcome measures. Statistical analyses performed Exploratory factor analysis and variability analysis were used to evaluate the draft scale, based on data from two rounds of investigation. The structure of the scale was explored through confirmatory factor analysis, and its reliability, construct validity, and discriminative ability were evaluated based on data from a third round of investigation. Results The Chinese Preschoolers’ Caregivers’ Feeding Behavior Scale (CPCFBS) consisted of 35 items and seven dimensions; the total cumulative variance contribution rate was 58.6%; the Cronbach’s α coefficient was .91; the split-half reliability coefficient was 0.89; and the test–retest reliability coefficient was 0.85. The age and weight status of the children and the caregivers’ age and education levels, as well as family incomes and child-caregiver relationships, were correlated with feeding behavior. Conclusions The CPCFBS appeared to have good reliability and construct validity in specific Chinese populations. Future studies are needed to confirm existing findings in different Chinese populations with larger sample sizes.

  • Foods Distributed During Federal Disaster Relief Response in Puerto Rico After Hurricane María Did Not Fully Meet Federal Nutrition Recommendations
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-06-12
    Uriyoán Colón-Ramos, Amira A. Roess, Kim Robien, Pietro D. Marghella, Ronald J. Waldman, Kathleen A. Merrigan

    Background Emergency foods distributed during a federal disaster relief response must follow the federal Dietary Guidelines for Americans according to the 1990 National Nutrition Monitoring Related Research Act. Nutrition information about emergency foods for household distribution is scarce. Methods According to structured observation protocols, foods received daily at a federal distribution center in Puerto Rico after Hurricane María (November 10-25, 2017) were grouped into Dietary Guidelines for Americans ChooseMyPlate food groups. Data about their sodium, saturated fat, added sugar, and fiber content per serving were captured. Registered dietitians designed meal plans with the foods distributed. Results Of 107 unique food items, 41% were snacks and sweets; and 13%, 4%, 13%, and 7% were fruits, vegetables, proteins, and grains, respectively. Fifty-eight percent of all foods were low in fiber (≤1 g); 46% included high amounts of sodium, saturated fats, or added sugars (≥20% daily value). The registered dietitians were able to design meal plans that complied with the Dietary Guidelines for Americans food group recommendations, but they exceeded upper daily limits for sodium, saturated fat, or added sugars. Conclusions In view of projected increases in natural disasters and diet-related chronic diseases, DGA compliance must be improved so that federal emergency foods can support the health of survivors.

  • Effects of Bariatric Surgery on Maternal and Infant Outcomes of Pregnancy—An Evidence Analysis Center Systematic Review
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-04-27
    Rima Itani Al-Nimr, Rubina Hakeem, Julie M. Moreschi, Sina Gallo, Joann M. McDermid, Maria Pari-Keener, Barbara Stahnke, Constantina Papoutsakis, Deepa Handu, Feon W. Cheng

    Background While obesity presents specific acute and long-term risks to the pregnant woman and her offspring, the effects of bariatric surgery on pregnancy outcomes are undetermined. Objective A systematic review was performed according to the Academy of Nutrition and Dietetics Evidence Analysis Library process to determine the effects of bariatric surgery on both maternal and infant health outcomes of pregnancy. Design A comprehensive literature search of PubMed was conducted to identify studies published from years 2000 to 2015 that examined the health effects of pregnancy after bariatric surgery. Experimental studies and observational studies with a control group were included. Main outcome measures Outcomes of interest were gestational weight gain, maternal complications (ie, gestational diabetes, pre-eclampsia, eclampsia, hypertension, and postpartum hemorrhage), miscarriage and/or stillbirth, cesarean section, birth weight in grams, birth weight in categories (ie, macrosomia, low birth weight, small for gestational age, and large for gestational age), gestational age and preterm birth, infant illness and complications (ie, perinatal death, admission to neonatal intensive care unit, neonatal illness, and congenital malformation rates), and Apgar scores. Results Thirteen of 246 studies were included. Compared to body mass index–matched controls without surgery, bariatric surgery before pregnancy reduced infant birth weight in grams, with no effect on total maternal gestational weight gain or Apgar scores. Surgery did not increase risk of adverse outcomes, such as miscarriage and/or stillbirth, preterm birth, or infant complications. Effects of surgery on maternal complications, infant birth weight categories, and surgical delivery rates were inconsistent. Conclusions Bariatric surgery is a successful treatment of maternal obesity, but certain surgery-specific risks may exist. More data are needed to determine clinical guidelines. The long-term effects of surgery on pregnancy outcomes are unknown.

  • Dietary Patterns Associated with the Prevalence of Cardiovascular Disease Risk Factors in Kuwaiti Adults
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-11-18
    Badreya Al-Lahou, Lynne M. Ausman, José L. Peñalvo, Gordon S. Huggins, Suad Al-Hooti, Sameer Al-Zenki, Fang Fang Zhang

    Background Kuwaiti adults have experienced a rapid increase in cardiovascular disease (CVD) and its risk factors. Dietary patterns in the Kuwaiti diet associated with the increasingly higher CVD burden have not been adequately evaluated. Objective The objective of this study was to identify the major dietary patterns in Kuwaiti adults and examine their associations with CVD risk factors. Design This cross-sectional study examined data from the 2008-2009 National Nutrition Survey of the State of Kuwait. Participants/setting The study included 555 Kuwaiti adults aged ≥20 years who completed a 24-hour dietary recall. Main outcome measures The outcome measures included CVD risk factors such as obesity (body mass index), abdominal obesity (waist circumference), elevated blood pressure, dyslipidemia (blood lipid levels), diabetes (glucose and glycated hemoglobin levels), and metabolic syndrome. Statistical analysis Dietary patterns were identified using principal component analysis. The associations between dietary patterns and CVD risk factors were analyzed using survey-weighted multivariable linear and logistic regression models. Results Three dietary patterns were identified: vegetable-rich, fast food, and refined grains/poultry. Younger adults had higher adherence to the fast-food or refined-grains/poultry dietary patterns, whereas older adults had higher adherence to the vegetable-rich dietary pattern. The fast-food dietary pattern was positively associated with body mass index (β=.94, 95% CI 0.08 to 1.79), waist circumference (β=2.05, 95% CI 0.20 to 3.90 cm), and diastolic blood pressure (β=1.62, 95% CI 0.47 to 2.77 mm Hg). The refined grains/poultry dietary pattern was positively associated with plasma glucose levels (β=1.02, 95% CI 1.002 to 1.04 mg/dL [0.056 to 0.058 mmol/L]). Individuals in the highest tertile of the fast-food or refined-grains/poultry dietary patterns had higher odds of metabolic syndrome than those in the lowest tertile. Conclusions The fast-food and refined grains/poultry dietary patterns were associated with high prevalence of CVD risk factors among Kuwaiti adults. The current findings underscore the need for prospective studies to further explore dietary pattern and CVD risk factor relationships among at-risk Kuwait adults.

  • Gender Expression and Sexual Orientation Differences in Diet Quality and Eating Habits from Adolescence to Young Adulthood
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-07-30
    Nicole A. VanKim, Heather L. Corliss, Hee-Jin Jun, Jerel P. Calzo, Manar AlAwadhi, S. Bryn Austin

    Background Diet and eating habits during youth have implications on diet and eating habits during adulthood, however, little longitudinal research has examined sexual orientation and gender expression differences in diet. Objective Our aim was to examine sexual orientation and gender expression differences in diet quality and eating habits from adolescence to young adulthood. Design Data across multiple time points from the longitudinal Growing Up Today Study cohorts (1997 to 2011) were used. Participants/setting Participants (n=12,880; aged 10 to 23 years) were the children of women from the Nurses’ Health Study II cohort. Main outcome measures Diet quality scores were assessed using the Alternative Healthy Eating Index-2010. In addition, breakfast consumption (≥5 days/wk) and family dinners (≥5 days/wk) were assessed. Statistical analyses performed Multivariable generalized estimating equation regression models were fit to estimate sexual orientation and gender expression differences in diet quality scores, breakfast consumption, and family dinners, stratified by sex assigned at birth over available repeated measures. Results “Gender-nonconforming” males had significantly higher diet quality scores than “very gender-conforming” males (P<0.05). Diet quality scores did not differ by gender expression among females. “Mostly heterosexual” females and gay males had higher diet quality scores than their same-sex completely heterosexual counterparts (P<0.05). Adjustment for mother’s diet quality scores attenuated effects, except for gay males (P<0.05). “Gender-nonconforming” females were less likely to consume breakfast than “very gender-conforming” females (P<0.05). Similar results were found for “mostly heterosexual” and bisexual compared to completely heterosexual females. There were no gender expression or sexual orientation differences in family dinners among males and females. Conclusions Sexual orientation and gender expression have independent effects on diet quality scores and eating habits for both males and females. Very gender-conforming and completely heterosexual males had the lowest diet quality scores compared to other gender expression and sexual orientation groups. Additional research to explore the effects of sexual orientation and gender expression on diet-related health is needed to build upon these findings.

  • Variations in Marginal Taste Perception by Body Mass Index Classification: A Randomized Controlled Trial
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-07-30
    Aaron C. Miller, Linnea A. Polgreen, Elena M. Segre, Philip M. Polgreen

    Background The propensity to overeat may, in part, be a function of the satisfaction derived from eating. If levels of satisfaction derived from food differ among normal-weight, overweight, and obese adults, the quantification of satisfaction from food may help explain why some people eat more than others. Objective To quantify the satisfaction obtained from eating one specific food, chocolate, by measuring taste perception as normal-weight, overweight, and obese participants consumed additional pieces of chocolate. To measure the effect of nutritional information on chocolate consumption. Design Randomized, controlled trial. Participants/setting We analyzed data on 290 adults; 161 had a body mass index (BMI) that was considered normal (<25), 78 had a BMI considered overweight (≥25 and <30), and 51 had a BMI considered obese (≥30). Intervention Participants were given samples of chocolate, one at a time, until they chose to stop eating. With each sample, participants were given a questionnaire. Half of the study participants were randomly selected to receive nutritional information (n=150). Main outcome measures Perceived taste for each sample. Statistical analyses performed We used time-series-regression to model perceived taste changes while controlling for participant characteristics. Results Study participants consumed between 2 and 51 pieces of chocolate with a mean of 12.1 pieces. Average taste perception decreased with each piece. We found no significant difference in taste perceptions between normal- and overweight participants. However, obese participants had higher levels of initial taste perception than normal- and overweight participants (P=0.02). Also, obese participants reported taste perceptions that declined at a more gradual rate than normal- and overweight participants (P<0.01). Self-reported hunger, prior to the study, affected taste perception, but providing nutritional information did not. Conclusions Obese participants started with higher levels of perceived taste and also experienced slower rates of decline than did normal-weight and overweight individuals.

  • Trends in Registered Dietitian Nutritionists’ Knowledge and Patterns of Coding, Billing, and Payment
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-07-25
    Bonnie T. Jortberg, J. Scott Parrott, Marsha Schofield, Eileen Myers, Keith T. Ayoob, Lucille Beseler, Amy Davis, Elizabeth Yakes Jimenez, Jessie Pavlinac, Karen Smith

    The US health care system has been undergoing substantial changes in reimbursement for medical and nutrition services. These changes have offered opportunities and challenges for registered dietitian nutritionists (RDNs) to bill for medical nutrition therapy and other nutrition-related services. During the past 10 years, the Academy of Nutrition and Dietetics has periodically surveyed RDNs providing medical nutrition therapy in ambulatory care settings to learn about their knowledge and patterns of coding, billing, and payment for their services. In 2018, the Academy of Nutrition and Dietetics conducted the latest iteration of this survey. This article compares the results of the 2008, 2013, and 2018 surveys to examine changes in RDNs’ knowledge of billing code use and reimbursement patterns over time; understand the potential influences on coding and billing practices in a changing health care environment; and understand the effects of newer practice settings and care delivery models on billing and reimbursement for medical nutrition therapy services. Results from these surveys demonstrate that during the past 10 years RDNs’ knowledge of billing and coding has been stable and very low for RDNs not in supervisory roles or private practice. RDNs reported an increase in providing medical nutrition therapy services to patients with multiple conditions. Since 2013, a dramatic increase was noted in the reported proportion of reimbursement from private/commercial health insurance plans. Results also indicate that most RDNs are not aware of changes in health care payment. Individual RDNs need to understand and be held accountable for the business side of practice and their value proposition in today’s health care environment.

  • Associations between Low-Carbohydrate Diets from Animal and Plant Sources and Dyslipidemia among Korean adults
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-07-23
    Seong-Ah Kim, Kyungjoon Lim, Sangah Shin

    Background The traditional Korean diet is relatively high in carbohydrate and low in fat and protein compared with diets of non-Asian populations. In recent decades, the rapid economic growth in Korea has led to lifestyle and dietary changes, with an increase in the prevalence of dyslipidemia, a risk factor for chronic diseases. Objective To examine the association between a low carbohydrate diet (LCD) score and dyslipidemia in Korean adults. Design The Korea National Health and Nutrition Examination Survey is an ongoing nationally representative population-based cross-sectional survey that is conducted annually. Participants/setting A total of 12,199 Korea National Health and Nutrition Examination Survey participants aged ≥20 years from 2010 to 2016 were included in this study. Main outcome measures Individual components of dyslipidemia, such as hypercholesterolemia, hypertriglyceridemia, and low high-density lipoprotein cholesterol levels, were defined based on fasting blood test results. Statistical analyses Participants were classified by sex into quintiles of LCD scores calculated using 1-day 24-hour dietary recall data. A multivariable logistic regression model was used to examine the association between LCD score and each dyslipidemia component after adjusting for potential confounders. Results A higher LCD score was significantly associated with higher odds of hypercholesterolemia (odds ratio 1.36, 95% CI, 1.05 to 1.78; P for trend=0.031) and lower odds of low high-density lipoprotein cholesterol levels (odds ratio 0.72, 95% CI 0.55 to 0.94; P for trend=0.002) in women. However, in men, higher LCD scores were significantly associated with lower odds of hypertriglyceridemia (odds ratio 0.70, 95% CI 0.52 to 0.95; P for trend=0.012). More specifically, animal-based LCD scores were negatively associated with the odds of hypertriglyceridemia (odds ratio 0.65, 95% CI 0.48 to 0.87; P for trend=0.010) in men. Conclusions These results suggest that the complicated and integrated effects of macronutrient composition on individual lipid components should be considered for preventing dyslipidemia in Korean adults.

  • Qualitative Research on the Real-Time Decision Making of WIC Participants While Food Shopping: Use of Think-Aloud Methodology
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-07-13
    Shannon M. Robson, Rosemary DeLuccia, Sandra Baker, Barry Bodt, Jillian Trabulsi

    Background People of lower socioeconomic status often experience disparities related to dietary intake as compared with People of higher socioeconomic status. Foods purchased influence the availability of foods in the home environment, and availability of foods in the home environment is associated with dietary intake. Objective To identify what factors influence food purchasing decisions of low-income parents while food shopping. Design A qualitative study using think-aloud methodology, the processing of information through verbalization concurrent with task performance, was used to verbally capture real-time decision making. Participants and setting Twenty-eight parents with a preschool-aged child enrolled in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Study visits took place at the WIC clinic office and local grocery stores. Main outcomes Reasons for making decisions while food shopping. Analysis Audio recordings were transcribed, and thematic analysis was used to analyze the data. Descriptive statistics were used to characterize demographics and shopping behaviors. Results A parent’s decision in a food purchase was based on child preference, value, need of an item, or the parent choice for a product. In addition, themes emerged related to participant shopping behavior included the influence of participation in WIC on food and beverage purchases, multiple trips to the store, and a frequent focus on purchasing bottled water and juice. The average shopping trip was 31.5±15.7 minutes, and the median amount spent was $38.61. Conclusion Understanding the influences of parent decisions while making food purchases can better help inform the nutrition education provided as part of WIC.

  • Remember Me? Exposure to Unfamiliar Food Brands in Television Advertising and Online Advergames Drives Children’s Brand Recognition, Attitudes, and Desire to Eat Foods: A Secondary Analysis from a Crossover Experimental-Control Study with Randomization at the Group Level
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-07-10
    Jennifer Norman, Bridget Kelly, Anne-T. McMahon, Emma Boyland, Kathy Chapman, Lesley King

    Background Limitations in current Australian regulatory provisions may be identified by demonstrating the effect of different marketing methods on children’s recognition and attitudes toward unhealthy food brands. Objective To investigate how exposure to different marketing techniques from television (TV) and online food advertising affects children’s brand recall, recognition, and attitudinal responses toward brands and brand consumers and children’s desire to eat the advertised products. Design Secondary analysis of data from a crossover experimental-control study. Participants/setting In all, 154 children (7 to 12 years) completed the study, conducted at four 6-day holiday camps from April 2016 to January 2017 in New South Wales, Australia. Children were assigned to a single-media (n=76) or multiple-media (n=78) condition. Intervention All children viewed 10 TV food advertisements in a cartoon on three occasions. For one of the brands, one set of children additionally played online “advergames” featuring the brand. Main outcome measures Children’s recognition and attitudes toward brands and brand consumers and children’s desire to eat the product were reported via a brand recognition and attitude survey pre- and postintervention. Marketing techniques were categorized. Statistical analysis Pre- and postintervention brand recognition and relationships between brand recognition and attitudes by media condition and desire to eat the product were examined using generalized linear mixed models and linear mixed models. Results There was a significant increase in the number of brands recognized postexposure by children in both media groups (mean difference=3.8, P<0.0001). The majority of brands appealed to children. Children who reported wanting to eat the advertised products rated brands more positively than children who did not express a desire to eat the products. A larger proportion of children who played the advergames (36%) rated brand consumers as “cool” than children who viewed the TV advertisements only (19%) (P<0.001). Anti-adult themes, fun and humor, and parent pleasing were techniques unique to some of the most recognized and favored advertisements. Conclusions The marketing communications increased children’s brand recognition and elicited positive attitudinal responses. These findings indicate a need for policy makers to consider additional regulations to protect children from the persuasive influence of unhealthy food advertising.

  • Protein Energy Malnutrition Is Associated with Worse Outcomes in Sepsis—A Nationwide Analysis
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-07-08
    Adeyinka Charles Adejumo, Olalekan Akanbi, Lydie Pani

    Background Protein-energy malnutrition (PEM), resulting from depleted energy and nutrient stores, compromises the body’s defense systems and may exacerbate sepsis and its impact. However, population-based studies examining the association of PEM on the prevalence and health-care burden of sepsis are lacking. Objective To investigate the relationship between PEM and sepsis, influence of PEM on clinical outcomes of sepsis, and impact of PEM on trends in sepsis mortality. Design The primary study is a retrospective cohort analysis of the 2012-2014 National Inpatient Sample (NIS) patient discharge records. Secondary analyses are cross-sectional study on the 2014 NIS and trend analysis on 2007-2014 NIS. Participants/setting The primary study included adult inpatient hospitalizations for sepsis in the United States. Main outcome measures Mortality, complicated sepsis, and 10 other metrics of clinical outcomes and health care utilization. Statistical analysis First, patients with sepsis (2014 NIS) were stratified into two groups: uncomplicated (without shock) and complicated (with shock). The adjusted odds ratio of having sepsis (total, uncomplicated, and complicated) was estimated with PEM as predictor using logistic regressions (binomial and multinomial). Second, among patients with sepsis (2012-2014 NIS), PEM cases were matched to cases without PEM (no-PEM) using a greedy-algorithm based propensity-matching methodology (1:1), and the outcomes were measured with conditional regression models. Finally, the trend in mortality from sepsis was calculated, stratified by PEM status, as an effect modifier, using Poisson models (2007-2014 NIS). All models accounted for the complex sampling methodology (SAS 9.4). Results In 2014, PEM was associated with higher odds for sepsis (3.97 [3.89 to 4.05], P<0.0001) and complicated vs uncomplicated sepsis (1.74 [1.67 to 1.81], P<0.0001). From 2012-2014, about 18% (167,133 of 908,552) of hospitalizations for sepsis had coexisting PEM. After propensity matching, PEM was associated with higher mortality (adjusted odds ratio: 1.35 [1.32 to 1.37], P<0.0001), cost ($160,724 [159,517 to 161,940] vs $86,650 [85,931 to 87,375], P<0.0001), length of stay (14.8 [14.9 to 14.8] vs 8.5 [8.5 to 8.6] days, P<0.0001), adverse events, and resource utilization. Although mortality in sepsis has been trending down from 2007-2014 (−1.19% per year, P trend<0.0001), the decrease was less pronounced among those with PEM vs no-PEM (−0.86% per year vs −1.29% per year, P<0.0001). Conclusions PEM is a risk factor for sepsis and associated with poorer outcomes among patients with sepsis. A concerted effort involving all health care workers in the prevention, identification, and treatment of PEM in community-dwelling people before hospitalization might mitigate against these devastating outcomes.

  • Consuming Vegetable-Based Salad Is Associated with Higher Nutrient Intakes and Diet Quality among US Adults, What We Eat in America, National Health and Nutrition Examination Survey 2011-2014
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-07-02
    M. Katherine Hoy, Rhonda S. Sebastian, Joseph D. Goldman, Cecilia Wilkinson Enns, Alanna J. Moshfegh

    Background Consuming salad is one strategy with the potential to harmonize diets more closely with national dietary guidance. However, it is not known whether nutrient intake and diet quality differ between people who consume vegetable-based salad and those who do not. Objective The objective of this study was to compare nutrient intake and diet quality between salad reporters and nonreporters. Design This study is a cross-sectional analysis of 1 day of dietary intake data collected via 24-hour recall. Participants/setting Adults 20 years and older (n=9,678) in What We Eat in America, National Health and Nutrition Examination Survey 2011-2014 were included. Respondents who ate salad on the intake day were considered salad reporters. Main outcome measures This study estimated nutrient intake from all foods and beverages (excluding supplements) and evaluated diet quality using the Healthy Eating Index (HEI) 2015. Statistical analyses Nutrient intake and HEI scores were compared between salad reporters and nonreporters using paired t tests with regression adjustment for confounding variables. Results were considered significant at P<0.001. Results On the intake day, 23% of adults consumed salad. Energy, protein, and carbohydrate intakes did not differ between salad reporters and nonreporters. Salad reporters had higher intakes than nonreporters of dietary fiber, total fat, unsaturated fatty acids, vitamins A, B-6, C, E, K, folate, choline, magnesium, potassium, and sodium (P<0.001). Total HEI 2015 scores were significantly higher for reporters (56 of a possible 100 points) than nonreporters (50 points) P<0.001. Reporters also had significantly higher scores for eight of 13 HEI components: total vegetables, greens and beans, whole fruits, total protein foods, seafood and plant proteins, fatty acids, refined grains, and added sugars (P<0.001). Conclusions Incorporating vegetable-based salad into one’s diet may be one effective way to increase nutrient intake and improve overall diet quality. Regardless of salad reporting status, HEI scores show that diets of US adults need improvement.

  • Nutrition Assessment in Crohn’s Disease using Anthropometric, Biochemical, and Dietary Indexes: A Narrative Review
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-06-24
    Alicia M. Sandall, Catherine L. Wall, Miranda C.E. Lomer

    Malnutrition is common in patients with Crohn’s disease and negatively influences immunity and quality of life. The optimal tools for nutrition assessment in patients with Crohn’s disease are not clearly defined and lead to variations in practice. With this review, we aimed to appraise the existing evidence for nutrition assessment of patients with Crohn’s disease compared with healthy controls and provide a comprehensive guide with relevant measures applicable to clinical practice. A literature search using Medline, Embase, and Scopus from inception to October 1, 2018, was conducted. Forty-one articles that assessed body composition, muscle strength, micronutrient status and/or dietary intake in adults with Crohn’s disease compared with an age- and sex-matched healthy individuals were included. There were heterogeneous findings on nutritional status in patients with Crohn’s disease compared with healthy controls. Only one article reported a clinically significant difference for body mass index; however, significant deficits in fat mass, fat-free mass, and muscle strength were observed in patients with Crohn’s disease compared with healthy controls, with more pronounced differences with increasing disease activity and length of diagnosis. Most research reported significantly lower serum micronutrients in patients with Crohn’s disease compared with healthy controls. Half of studies measuring micronutrient intake reported lower intakes in patients with Crohn’s disease compared with healthy controls. Fruit and vegetable intake was also lower in patients with Crohn’s disease. Difficulties characterizing the type and prevalence of malnutrition exist due to the heterogeneous nature of Crohn’s disease and warrants continued investigation. As a result of this review, we advocate that a nutrition assessment should include more parameters than weight and body mass index.

  • Characteristics and Drivers of the Registered Dietitian Nutritionist’s Sustained Involvement in Clinical Research Activities: A Mixed Methods Study
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-06-11
    Melinda Boyd, Stephanie B. Gall, Pamela Rothpletz-Puglia, J. Scott Parrott, Carrie King, Laura Byham-Gray

    Background Research contributions by registered dietitian nutritionists (RDNs) are important for enhancing the use of nutrition-related evidence-based guidelines in dietetics practice. Involvement of RDNs in research activities has been studied previously, but little is known about the drivers (motivators) of sustaining research involvement by RDNs who work in clinical practice. Objective To identify key characteristics of established RDN clinician researchers and drivers that contributed to their sustained research involvement. Design We used a convergent parallel mixed methods study design utilizing the clinician career research trajectory as a framework. Research involvement was examined using the Practice-Based Dietitian Research Involvement Survey (PBDRIS). Workplace support was assessed using the Research Capacity and Culture (RCC) survey. Semistructured interviews were used to investigate key themes in established RDN clinician researchers. Participants/setting We identified 450 RDNs involved with research activities in the United States through hand-searching clinically relevant nutrition journals and contacted them to participate in an online survey. A total of 29 RDNs met criteria and completed (6.4%) the quantitative survey, then a subsample (n=10) participated in semistructured interviews to explore drivers for continued research involvement. Results Research involvement scores (n=29) from the PBDRIS ranged from 60.0% to 97.5%, indicating involvement in higher-level research-related tasks by our sample participants. RCC results revealed the importance of workplace support and mentorship. Interviews with established RDN clinician researchers identified exposure, curiosity, and dedication as three overarching themes with eight subthemes driving continued research involvement. Conclusion Based on the experiences of select RDN clinician researchers who have demonstrated success in sustaining their research involvement, we found that having an available mentor, support from their workplace environment, and personal drive were integral to their success.

  • Pilot Evaluation of Aggregate Plate Waste as a Measure of Students’ School Lunch Consumption
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-05-29
    Leah Elizabeth Chapman, Scott Richardson, Lori McLeod, Eric Rimm, Juliana Cohen

    Background Weighing an individual’s plate waste provides reliable estimates of food intake by physically weighing individual food components to the nearest gram before and after a meal. Weighing aggregate, school-level food waste may be an inexpensive and less time-consuming alternative. However, it has not been determined whether aggregate plate waste is an accurate measure of individually weighed plate waste. Objective This pilot study aimed to evaluate the accuracy of aggregate plate waste for quantifying food waste in a school cafeteria setting in comparison with individually weighed plate waste. Design A pilot validation study in which aggregate plate waste was compared against individually weighed plate waste in a school cafeteria setting. Participants/setting This study took place in an urban, low-income school district in Massachusetts in the spring of 2014. Four elementary schools with identical cafeterias and meals participated in the study. Approximately 1,700 students participated in this study. Main outcome measures For individually weighed plate waste, the percent discarded was calculated by dividing the weight of each discarded item by the average weight of the food item served and the percent consumed was calculated as the residual. For aggregate-level measurements, waste was separated by component (entrée, vegetable, fruit, and milk), and the weight discarded was calculated based on the weight of the cumulative amount remaining and an average weight for each food item served, with the percent consumed calculated as the residual. Statistical analyses performed Intraclass correlation coefficients (ICCs) were calculated to assess the agreement between aggregate plate waste and individual-level plate waste values. Results Agreement was excellent for entrées (ICC=0.90) and vegetables (ICC=0.78), but poor for milk (ICC=0.22) and fruits (ICC=0.23). The overall agreement for all four components combined was excellent (ICC=0.75). Conclusions Results suggest that aggregate plate waste may provide a reasonable estimate of individually weighed plate waste, but additional research is warranted.

  • The Impact of a 4-Week Low-FODMAP and mNICE Diet on Nutrient Intake in a Sample of US Adults with Irritable Bowel Syndrome with Diarrhea
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-05-15
    Shanti Eswaran, Russell D. Dolan, Sarah C. Ball, Kenya Jackson, William Chey

    Background A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) has gained increasing acceptance for the treatment of irritable bowel syndrome but safety concerns have been raised regarding nutritional adequacy. Changes in nutrient intake during the elimination phase of the low-FODMAP diet remain predominantly unknown. Objective To determine changes in the mean reported daily nutrient content before and after 4 weeks of a low-FODMAP diet vs modified National Institute for Health and Clinical Excellence (mNICE) dietary intervention and to identify nutritional inadequacies based on comparison to the Dietary Reference Intakes in patients with irritable bowel syndrome-diarrhea subtype. Design Post hoc analysis of a randomized controlled trial entailing a 4-week trial period comparing the low-FODMAP and mNICE diets. Participants and setting A total of 78 patients (41 low FODMAP and 37 mNICE) meeting the Rome III criteria for irritable bowel syndrome-diarrhea subtype were consecutively recruited from gastroenterology and primary care clinics at the University of Michigan Medical Center between October 2012 and November 2015. Methods Participants randomized to the low-FODMAP arm were instructed to decrease their dietary intake of FODMAPs, whereas participants randomized to the mNICE intervention arm were instructed to eat small frequent meals, avoid trigger foods, and avoid excess alcohol and caffeine. Main outcome measures Post hoc evaluation for presence of micronutrient deficiencies per Dietary Reference Intakes when implementing low-FODMAP vs mNICE dietary interventions. Dietary intake was analyzed via 3-day food diaries at baseline and during the final week of the assigned diet. Statistical analyses performed A post hoc analysis utilizing either a t test or χ2 analysis was conducted between before and after data. Results Both diets resulted in fewer daily kilocalories consumed, fewer number of daily meals consumed, and less daily carbohydrate intake. Among the patients following the low-FODMAP diet, there was a statistically significant decrease from baseline in several micronutrients, which was not observed in the mNICE cohort. However, these differences in the low-FODMAP group remained significant only for riboflavin after correcting for calorie-adjusted nutrient intake. Comparing Dietary Reference Intakes of participants pre- and postintervention, fewer patients met the Dietary Reference Intakes for thiamin and iron in the low FODMAP group, and for calcium and copper in the mNICE group. Conclusions During a 4-week dietary intervention, the mean daily intake of most micronutrients remained stable and within the Recommended Dietary Allowances for both diets. Although decrease in several micronutrients was observed with implementation of the low-FODMAP diet relative to the mNICE diet, most of these disappeared after adjusting for energy intake.

  • Nutrient Intake, Diet Quality, and Diet Diversity in Irritable Bowel Syndrome and the Impact of the Low FODMAP Diet
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-04-24
    Heidi M. Staudacher, Frances S.E. Ralph, Peter M. Irving, Kevin Whelan, Miranda C.E. Lomer

    Background Individuals with irritable bowel syndrome (IBS) may modify their diet, which may pose nutritional risk. Further, some dietary approaches, such as a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), are restrictive and may contribute to nutritional inadequacy. Objective Our aim was to evaluate habitual nutrient intake, diet quality, and diversity in IBS and the effect of a 4-week low FODMAP diet on these parameters compared with controls. Design Data from two randomized controlled trials were included for this secondary analysis. Participants were randomized to low FODMAP diet (n=63) or control diet (sham diet n=48, habitual diet n=19). Participants/setting Participants included 130 individuals with IBS referred to a tertiary center in London, UK between January 2010 to June 2011 and January 2013 to November 2014. Intervention Participants in one trial were randomized to receive either low FODMAP dietary counseling or sham control dietary counseling. In the other, they were randomized to receive low FODMAP dietary counseling or to continue habitual diet. All advice was provided by a specialist dietitian. Main outcome measures Habitual (usual) dietary intake at baseline (n=130) and after a 4-week intervention period was measured using 7-day food records. Statistical analyses performed Analysis of covariance and χ2 tests evaluated differences across groups at 4 weeks. Results When examining habitual intake of individuals with IBS, fiber intake was low, with only 6 (5%) achieving the target (30 g/day). In those receiving low FODMAP advice, there was no difference in intake of most nutrients compared with controls. However, there was lower intake of starch (109 g/day) vs habitual control diet (128 g/day; P=0.030), and higher intake of vitamin B-12 (6.1 μg/day) vs habitual (3.9 μg/day) and sham control diets (4.7 μg/day; P<0.01). Overall scores for diet quality were lower after low FODMAP advice vs habitual control diet (P<0.01). Conclusion This study demonstrates many individuals with IBS fail to meet dietary reference values for multiple nutrients. A 4-week low FODMAP diet, when delivered by a specialist dietitian, does not impact on intake of most nutrients or diet diversity but decreases diet quality compared with control diets.

  • The Effects of Prebiotics and Substances with Prebiotic Properties on Metabolic and Inflammatory Biomarkers in Individuals with Type 2 Diabetes Mellitus: A Systematic Review
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-02-28
    Angela G. Colantonio, Sharon L. Werner, Melissa Brown

    Background Intestinal bacteria composition and prebiotics may play a role in the management of type 2 diabetes mellitus (T2DM). Objective The objective of this systematic review was to evaluate the effect of prebiotics and substances with prebiotic properties on the metabolic and inflammatory biomarkers of individuals with T2DM compared with placebo. Methods A literature search to identify articles published up to March 31, 2018, was conducted utilizing PubMed, Science Direct, and Cochrane Central Register of Controlled Trials. Individuals at aged 18 years or older with T2DM from randomized controlled trials investigating prebiotics or substances with prebiotic properties were included. Metabolic and inflammatory biomarkers associated with T2DM were the primary outcome measures. Results Twenty-seven publications were analyzed. All but seven of these publications reported a beneficial effect on metabolic and/or inflammatory biomarkers. Interventions included mostly women, lasted 4 days to 12 weeks, and diabetes duration ranged from 6 months to 11 years. Nineteen publications reported improvements in glycemia, 15 in cardiovascular markers, nine in body weight, and nine in inflammatory markers. Benefits from resistant starch, resistant dextrin, and oligofructose-enriched inulin were most frequent. A smaller number of studies utilizing other substances with prebiotic properties also yielded improvements. Conclusions Based on these results, there is fair evidence that prebiotics and substances with prebiotic properties may improve metabolic and inflammatory biomarkers related to T2DM in women aged 18 years at least. Interventions with resistant starch, resistant dextrin, and oligofructose-enriched inulin exhibited the strongest evidence for improvements due to the quantity of publications and quality grades. Other prebiotics and substances with prebiotic properties show promise but the number of studies is few. Additional studies that are longer in duration, include both sexes, and include other prebiotics or substances with prebiotic properties are needed.

  • 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 4.141) 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.

  • Added Sugars Intake among US Infants and Toddlers
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-11-14
    Kirsten A. Herrick, Cheryl D. Fryar, Heather C. Hamner, Sohyun Park, Cynthia L. Ogden

    Background Limited information is available on added sugars consumption in US infants and toddlers. Objectives To present national estimates of added sugars intake among US infants and toddlers by sociodemographic characteristics, to identify top sources of added sugars, and to examine trends in added sugars intake. Design Cross-sectional analysis of 1 day of 24-hour dietary recall data. Participants/setting A nationally representative sample of US infants aged 0 to 11 months and toddlers aged 12 to 23 months (n=1,211) during the period from 2011 through 2016 from the National Health and Nutrition Examination Survey. Trends were assessed from 2005-2006 through 2015-2016 (n=2,795). Main outcome measures Among infants and toddlers, the proportion consuming any added sugars, the average amount of added sugars consumed, percent of total energy from added sugars, and top sources of added sugars intake. Statistical analysis Paired t tests were used to compare differences by age, sex, race/Hispanic origin, family income level, and head of household education level. Trends were tested using orthogonal polynomials. Significance was set at P<0.05. Results During 2011 to 2016, 84.4% of infants and toddlers consumed added sugars on a given day. A greater proportion of toddlers (98.3%) consumed added sugars than infants (60.6%). The mean amount of added sugars toddlers consumed was also more compared with infants (5.8 vs 0.9 tsp). Non-Hispanic black toddlers (8.2 tsp) consumed more added sugars than non-Hispanic Asian (3.7 tsp), non-Hispanic white (5.3 tsp), and Hispanic (5.9 tsp) toddlers. A similar pattern was observed for percent energy from added sugars. For infants, top sources of added sugars were yogurt, baby food snacks/sweets, and sweet bakery products; top sources among toddlers were fruit drinks, sugars/sweets, and sweet bakery products. The mean amount of added sugars decreased from 2005-2006 through 2015-2016 for both age groups; however, percent energy from added sugars only decreased among infants. Conclusion Added sugars intake was observed among infants/toddlers and varied by age and race and Hispanic origin. Added sugars intake, as a percent of energy, decreased only among infants from 2005 to 2016.

  • Ratios of Food Amounts across Three Portion Size Categories on a Food Frequency Questionnaire in Men and Women
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-11-12
    Minji Kang, Song-Yi Park, Carol J. Boushey, Lynne R. Wilkens, Loïc Le Marchand, Laurence N. Kolonel, Suzanne P. Murphy, Hee-Young Paik

    Background For some quantitative food frequency questionnaire (QFFQ) items, data may be insufficient to set gram weights for multiple portion size (PS) categories. Ratios of food amounts across PS categories may be used to quantify these PS for less frequently consumed food items. Objective To explore the ratios of food amounts reported in 24-hour dietary recalls (24HDRs) by a sample of participants in a cohort study who chose the A (smallest) or C (largest) PS category on the QFFQ, relative to the food amounts for those who chose the B PS category. Design This study was conducted as a cross-sectional design. Participants/setting Data were from participants (n=2,360) who completed three 24HDRs and the QFFQ in a calibration study of the Multiethnic Cohort Study in 1994-1997. Main outcome measures Median food amounts were calculated from 24HDRs for participants who selected each PS category (A, smallest; B; and C, largest) of items on the QFFQ. A-to-B and C-to-B ratios were computed if reported by five or more people in the 24HDRs: A-to-B ratios for 68 items (men) and 88 items (women); C-to-B ratios for 93 items (men) and 79 items (women). Statistical analyses performed The t test was used to compare the mean A-to-B ratios and C-to-B ratios as preset on the QFFQ with those from the 24HDRs and to examine sex differences. Analysis of variance was used to compare the mean ratios among race and ethnicity groups. Results Mean A-to-B and C-to-B ratios were 0.71±0.15 and 1.45±0.35 in men and 0.71±0.15 and 1.44±0.40 in women based on the 24HDRs. Compared with the original QFFQ PS (A-to-B ratio=0.5±0.07; C-to-B ratio=1.8±0.30), the ratios were closer to 1 both in men and women (P<0.001). There were no significant sex differences or racial or ethnic differences. Conclusions These results provide guidance on appropriate ratios to use to set values for small and large PS categories on a QFFQ, particularly for items with insufficient information on usual PS.

  • Ethnic Differences in Dietary Management of Gestational Diabetes Mellitus: A Mixed Methods Study Comparing Ethnic Chinese Immigrants and Australian Women
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-11-09
    Ching Shan Wan, Helena Teede, Alison Nankervis, Rosalie Aroni

    Background Dietary modification is the primary intervention strategy for management of gestational diabetes mellitus (GDM), which usually occurs in the third trimester of pregnancy when women have extra nutritional needs. There is a high migration rate of ethnic Chinese people to Western countries, and those women present a high-risk group for GDM. Little is known about diet, dietary self-management, and nutritional supplementation use among ethnic Chinese migrant women with GDM compared with members of the host population with GDM. Objective This study aimed to compare the perceptions and experiences of dietary self-management and nutritional needs of ethnic Chinese migrants with those of Australian-born white women with GDM in Australia. Design A predominantly qualitative mixed methods approach with a quantitative component was used. Data collection involved in-depth, semistructured interviews, and 3-day 24-hour recall diaries collected concurrently. Data analysis and management relied on NVivo (QSR International Pty Ltd), FoodWorks (FoodWorks Professional 2017, Xyris Software), and SPSS (SPSS Inc). Pearson χ2 test, independent-samples t test, and Mann-Whitney U test were used to compare nutrient intakes between groups. The Pearson correlation was used to determine the relationship between dietary patterns and nutrient intake. Participants A total of 44 ethnic Chinese and 39 Australian-born white participants with GDM were recruited from two large Australian maternity services located in tertiary hospitals. Results Ethnic differences in satisfaction with GDM education influenced GDM self-management. Ethnic Chinese women with GDM perceived dietary advice received from health professionals to be lacking in cultural relevance and detail and responded by restricting their dietary intake and relying on nutritional supplementation. The perceived benefits of specific supplements produced ethnic differences in the patterns of supplement use. Cultural dietary patterns influenced dietary adequacy in pregnancy. Conclusions This study suggests the need for provision of more concrete, prescriptive, and culturally relevant dietary and supplementation advice for ethnic Chinese women with GDM.

  • Consensus Recommendations for Optimizing Electronic Health Records for Nutrition Care
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-11-01
    Cassandra E. Kight, Jean M. Bouche, Angie Curry, David Frankenfield, Katy Good, Peggi Guenter, Brian Murphy, Constantina Papoutsakis, Emily Brown Richards, Vincent W. Vanek, Deanne Wilk, Amy Wootton

    Provision of nutrition care is vital to the health and well-being of any patient who enters the health care system, whether in the ambulatory, inpatient, or long-term care setting. Interdisciplinary professionals—nurses, physicians, advanced practice providers, pharmacists, and dietitians—identify and treat nutrition problems or clinical conditions in each of these health care settings. The documentation of nutrition care in a structured format from screening and assessment to discharge allows communication of the nutrition treatment plans. The goal of this document is to provide recommendations to clinicians for working with an organization’s Information Systems department to create tools for documentation of nutrition care in the electronic health record. These recommendations can also serve as guidance for health care organizations choosing and implementing health care software.

  • Nutritional Quality of Meals and Snacks Served and Consumed in Family Child Care.
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2018-12-01
    Alison Tovar,Sara E Benjamin-Neelon,Amber E Vaughn,Maggie Tsai,Regan Burney,Truls Østbye,Dianne S Ward

    BACKGROUND Improving the nutritional quality of food, including beverages, served in early care and education settings should enhance children's diet quality. However, few studies have explored the relationship between what is served and consumed in family child-care homes (FCCHs). OBJECTIVE To describe the nutritional quality of food served to children in FCCHs and to assess the extent to which children eat what is served. DESIGN This study was a cross-sectional analysis using baseline data (n=166) from a cluster-randomized controlled trial (2013-2016). PARTICIPANTS/SETTING Eligible FCCHs in central North Carolina had to have at least two children between 18 months and 4 years, have been in business for at least 2 years, and serve at least one meal and one snack. MAIN OUTCOME MEASURES Food was captured using the Diet Observation at Child Care protocol. STATISTICAL ANALYSES Frequencies, means, and multivariate analysis were used to examine the relationship between food served and consumed by food groups and by Healthy Eating Index (HEI-2010). RESULTS Children consumed between 61% and 80% of what was served, with vegetables having the lowest percent consumed (61.0%). Total HEI-2010 score for food served was 63.6 (10.4) and for food consumed was 61.7 (11.5) out of a 100-point maximum. With regards to food served, FCCH providers came close to meeting HEI-2010 standards for dairy, whole fruit, total fruit, and empty calories. However, providers appeared to fall short when it came to greens and beans, seafood and plant proteins, total vegetables, whole grains, and fatty acids. They also exceeded recommended limits for sodium and refined grains. CONCLUSIONS Although FCCHs are serving some healthy food, mainly fruit, dairy, and few empty calories, there is room for improvement with regards to vegetables, grains, seafood and plant protein, fatty acids, and sodium. Future trainings should help providers find ways to increase the serving and consumption of these foods.

  • Food Insecurity and the Nutrition Care Process: Practical Applications for Dietetics Practitioners.
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2017-12-09
    Marianna S Wetherill,Kayla Castleberry White,Christine Rivera

  • Nutrition Standards Called into Question at Border Detainment Facilities.
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : null
    Hannah Martin,Jeanne Blankenship

  • 更新日期:2019-11-01
  • Sharing Our Time, Energy, and Expertise.
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : null
    Terri J Raymond

  • Analyzing Registered Dietitian Nutritionist Productivity Benchmarks for Acute Care Hospitals.
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2019-07-03
    Wendy Phillips,Maureen Janowski,Holly Brennan,Gisele Leger

  • Academy of Nutrition and Dietetics: Revised 2018 Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Education of Nutrition and Dietetics Practitioners.
    J. Acad. Nutr. Diet. (IF 4.141) Pub Date : 2018-12-24
    Kathleen Border,Cynthia Endrizal,Malinda Cecil

    Registered dietitian nutritionists (RDNs) engaged in education of nutrition and dietetics practitioners facilitate meaningful learning of required knowledge and supervised practice competencies in nutrition and dietetics curricula and proactively support all facets of the learning environment. Addressing the unique needs of each educational situation and applying standards appropriately is essential to providing evidenced-based, learner-centered, up-to-date education for future nutrition and dietetics practitioners. The Academy of Nutrition and Dietetics (Academy) leads the profession by developing standards that can be used by RDNs for self-evaluation to assess quality of practice and performance. The Standards of Professional Performance consist of six domains of professional performance: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, specific indicators provide measurable action statements that illustrate how the standard can be applied to practice. The Academy's Revised 2018 Standards of Professional Performance for RDNs in Education of Nutrition and Dietetics Practitioners provide standards and indicators for three levels of practice-competent, proficient, and expert-which are used to gauge and guide an RDN's performance in nutrition and dietetics practice in educational settings.

Contents have been reproduced by permission of the publishers.
上海纽约大学William Glover