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Acciai F, Uehara S, Ojinnaka C, Yedidia MJ, Ohri-Vachaspati P. The association between unhealthy dietary behaviors and participation in the Supplemental Nutrition Assistance Program (SNAP): No evidence in support of the self-selection hypothesis. Appetite 2024; 197:107302. [PMID: 38462052 PMCID: PMC11045168 DOI: 10.1016/j.appet.2024.107302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/21/2024] [Accepted: 03/07/2024] [Indexed: 03/12/2024]
Abstract
Supplemental Nutrition Assistance Program (SNAP) participants tend to have unhealthier dietary consumption compared to eligible non-participants. It has been suggested, though never empirically tested, that individuals who enroll in SNAP may have unhealthy diets prior to program participation. Using a longitudinal cohort study design, we examined the association between low-income adults' SNAP participation status and prior dietary behaviors to test the argument that individuals with unhealthier dietary consumption self-select into SNAP. A sample of households from predominantly lower-income cities were surveyed at baseline (T1) and 2-4 years later (T2). The main analyses were restricted to adults who did not participate in SNAP at T1 and with household income <200% of the federal poverty line (n = 170) at both T1 and T2. Participants were grouped into two categories, based on their SNAP participation at T2; (a) Non-participants (n = 132): no SNAP participation at T1 or T2, and (b) T2 SNAP participants (n = 38): SNAP participation at T2 but not T1. Daily consumption frequency of whole fruits, fruit juice, vegetables, sugar-sweetened beverages (SSBs), and energy dense snacks were measured through self-reports. To observe dietary differences between the two groups prior to SNAP participation, T1 behaviors were compared. There were no significant differences in dietary behaviors at T1 (prior to SNAP participation) between non-participants and T2 participants, providing no evidence of self-selection of individuals with unhealthier dietary consumption into SNAP among our study sample. Improvements in SNAP participants' diets may benefit from focusing on policy changes that encourage healthy dietary habits during participation in the program.
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Affiliation(s)
- Francesco Acciai
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA.
| | - Sarah Uehara
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Chinedum Ojinnaka
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Michael J Yedidia
- Center for State Health Policy, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
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Zhang M, Wei J, Sun Y, He C, Ma S, Pan X, Zhu X. The efferocytosis process in aging: Supporting evidence, mechanisms, and therapeutic prospects for age-related diseases. J Adv Res 2024:S2090-1232(24)00109-7. [PMID: 38499245 DOI: 10.1016/j.jare.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Aging is characterized by an ongoing struggle between the buildup of damage caused by a combination of external and internal factors. Aging has different effects on phagocytes, including impaired efferocytosis. A deficiency in efferocytosis can cause chronic inflammation, aging, and several other clinical disorders. AIM OF REVIEW Our review underscores the possible feasibility and extensive scope of employing dual targets in various age-related diseases to reduce the occurrence and progression of age-related diseases, ultimately fostering healthy aging and increasing lifespan. Key scientific concepts of review Hence, the concurrent implementation of strategies aimed at augmenting efferocytic mechanisms and anti-aging treatments has the potential to serve as a potent intervention for extending the duration of a healthy lifespan. In this review, we comprehensively discuss the concept and physiological effects of efferocytosis. Subsequently, we investigated the association between efferocytosis and the hallmarks of aging. Finally, we discuss growing evidence regarding therapeutic interventions for age-related disorders, focusing on the physiological processes of aging and efferocytosis.
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Affiliation(s)
- Meng Zhang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Jin Wei
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Yu Sun
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Chang He
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Shiyin Ma
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Xudong Pan
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao 266000, China.
| | - Xiaoyan Zhu
- Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266000, China.
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Lee K, Zhao S. Do Household Headship and Gender Affect Diet Quality under the Supplemental Nutrition Assistance Program (SNAP)? Am J Health Promot 2024; 38:349-354. [PMID: 37891714 DOI: 10.1177/08901171231211158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
PURPOSE Examine whether the association between Supplemental Nutrition Assistance Program (SNAP) participation and diet quality is different by gender and household headship. DESIGN Quantitative, cross-sectional. SETTING The 2007-2018 waves of the National Health and Nutrition Examination Survey (NHANES). SUBJECTS 6180 individuals aged 20 to 65 with household annual income below 130% of the poverty level. MEASURES The outcome of diet quality was measured using the 2015 Healthy Eating Index (HEI) based on dietary intake from 24-hour diet recall. The exposures were self-reported participation in SNAP and socio-demographic variables. ANALYSIS Ordinary Least Square (OLS) regression models. RESULTS The study found that female household heads had higher average total HEI scores relative to their male and non-head counterparts (β = 1.81, 95% CI: -.27, 3.88). However, for SNAP participants, female household heads had lower average total HEI scores (β = -3.67, 95% CI: -7.36, .11). CONCLUSION Female household heads are more likely to experience difficulty in maintaining diet quality relative to their counterparts. The study suggests that intra-household effort allocation may play an important role in differentiating and maintaining diet quality.
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Affiliation(s)
- Keehyun Lee
- Department of Agricultural Economics, University of Kentucky, Lexington, KY, USA
| | - Shuoli Zhao
- Department of Agricultural Economics, University of Kentucky, Lexington, KY, USA
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Chan SWC, Chin M, Suss R, Kui K, Lam SZ, Dowd E, Bosen C, Mei S, Barth K, Hughes M, Yi SS. A Culturally Specific Community Supported Agriculture (CSA) Program to Improve Diet in Immigrant Communities in Brooklyn, New York. Health Promot Pract 2024:15248399241234058. [PMID: 38415651 DOI: 10.1177/15248399241234058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Anti-Asian and anti-immigrant sentiment has surged in the country in the last 3 years. Food insecurity is also on the rise; in our local needs assessment of n = 1,270 Asian American adults in New York City, accessing food was cited as the number 1 priority among those who needed help. Finally, racial discrimination and food access are related to fear of being attacked-driving feelings of safety and therefore willingness to travel for food. To combat these narratives and leveraging pivots by our community partners, we implemented a community-supported agriculture pilot program (n = 38) to assess whether culturally appropriate food access can improve diet and foster cross-cultural learning among immigrant families in Brooklyn, NY. Over a 20-week period from June to October 2022, participants received Chinese-specific produce and nutrition education. Participants reported eating more and a greater variety of vegetables and had higher vegetable intake measured via skin carotenoid scores. This pilot may inform the adaptation of nutrition interventions to reduce inequities in chronic diseases in immigrant communities.
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Affiliation(s)
| | - Matthew Chin
- NYU Grossman School of Medicine, New York, NY, USA
| | - Rachel Suss
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Kiran Kui
- Tufts Medical Center, Boston, MA, USA
| | | | | | | | - Steve Mei
- Chinese American Planning Council, New York, NY, USA
| | | | - Michelle Hughes
- Glynwood Center for Regional Food and Farming, Cold Spring, NY, USA
| | - Stella S Yi
- NYU Grossman School of Medicine, New York, NY, USA
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Reeder NK, Reneker JC, Beech BM, Bruce MA, Heitman E, Norris KC, Talegawkar SA, Thorpe RJ. Adherence to the healthy eating index-2010 and alternative healthy eating index-2010 in relation to metabolic syndrome among African Americans in the Jackson heart study. Public Health Nutr 2024; 27:e74. [PMID: 38361460 PMCID: PMC10966834 DOI: 10.1017/s1368980024000016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 11/11/2023] [Accepted: 12/21/2023] [Indexed: 02/17/2024]
Abstract
OBJECTIVE The primary objective of this study was to determine whether Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI) scores were associated with incident metabolic syndrome. DESIGN This study is a secondary analysis of data from the Jackson Heart Study. HEI and AHEI scores were divided into quintiles and Cox proportional hazards regression models were analysed for 1864 African American adults free from metabolic syndrome at Exam 1 to examine the incidence of metabolic syndrome by quintile of dietary quality score. SETTING Hinds, Madison and Rankin counties, Mississippi, USA. PARTICIPANTS African American adults, ages 21-94 years, 60·9 % female. RESULTS Over a mean follow-up time of 6·7 years, we observed 932 incident cases of metabolic syndrome. After adjusting for multiple covariates, a higher HEI score at Exam 1 was not associated with the risk of incident metabolic syndrome, except when looking at the trend analysis for the subgroup of adults with two metabolic syndrome components at Exam 1 (P-trend = 0·03). A higher AHEI score at Exam 1 was associated with the risk of incident metabolic syndrome (hazard ratio for those in the highest quintile compared to the lowest: 0·80 (95 % CI: 0·65, 0·99), P-trend = 0·03). CONCLUSION These findings suggest that a dietary pattern that scores higher on the AHEI may help reduce the risk of metabolic syndrome, even for adults who already have two of the minimum of three components required for a diagnosis of metabolic syndrome.
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Affiliation(s)
- Nicole K Reeder
- Department of Food Science, Nutrition, and Health Promotion, Mississippi State University, Mississippi State, MS, USA
| | - Jennifer C Reneker
- Department of Population Health Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Bettina M Beech
- UH Population Health, University of Houston, Houston, TX, USA
| | - Marino A Bruce
- UH Population Health, University of Houston, Houston, TX, USA
- Department of Behavioral and Social Sciences, University of Houston, Tilman J. Fertitta Family College of Medicine, Houston, TX, USA
| | - Elizabeth Heitman
- Program in Ethics in Science and Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Keith C Norris
- Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sameera A Talegawkar
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins School of Public Health, 624 N. Broadway, Ste 708, Baltimore, MD, USA
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Frank SM, Jaacks LM, Avery CL, Adair LS, Meyer K, Rose D, Taillie LS. Dietary quality and cardiometabolic indicators in the USA: A comparison of the Planetary Health Diet Index, Healthy Eating Index-2015, and Dietary Approaches to Stop Hypertension. PLoS One 2024; 19:e0296069. [PMID: 38198440 PMCID: PMC10781024 DOI: 10.1371/journal.pone.0296069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The Planetary Health Diet Index (PHDI) measures adherence to the sustainable dietary guidance proposed by the EAT-Lancet Commission on Food, Planet, Health. To justify incorporating sustainable dietary guidance such as the PHDI in the US, the index needs to be compared to health-focused dietary recommendations already in use. The objectives of this study were to compare the how the Planetary Health Diet Index (PHDI), the Healthy Eating Index-2015 (HEI-2015) and Dietary Approaches to Stop Hypertension (DASH) relate to cardiometabolic risk factors. METHODS AND FINDINGS Participants from the National Health and Nutrition Examination Survey (2015-2018) were assigned a score for each dietary index. We examined disparities in dietary quality for each index. We used linear and logistic regression to assess the association of standardized dietary index values with waist circumference, blood pressure, HDL-C, fasting plasma glucose (FPG) and triglycerides (TG). We also dichotomized the cardiometabolic indicators using the cutoffs for the Metabolic Syndrome and used logistic regression to assess the relationship of the standardized dietary index values with binary cardiometabolic risk factors. We observed diet quality disparities for populations that were Black, Hispanic, low-income, and low-education. Higher diet quality was associated with improved continuous and binary cardiometabolic risk factors, although higher PHDI was not associated with high FPG and was the only index associated with lower TG. These patterns remained consistent in sensitivity analyses. CONCLUSIONS Sustainability-focused dietary recommendations such as the PHDI have similar cross-sectional associations with cardiometabolic risk as HEI-2015 or DASH. Health-focused dietary guidelines such as the forthcoming 2025-2030 Dietary Guidelines for Americans can consider the environmental impact of diet and still promote cardiometabolic health.
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Affiliation(s)
- Sarah M. Frank
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Midlothian, United Kingdom
| | - Lindsay M. Jaacks
- Global Academy of Agriculture and Food Systems, University of Edinburgh, Midlothian, United Kingdom
| | - Christy L. Avery
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Linda S. Adair
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Katie Meyer
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Nutrition Research Institute, University of North Carolina at Chapel Hill, Kannapolis, North Carolina, United States of America
| | - Donald Rose
- Tulane Nutrition, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Los Angeles, United States of America
| | - Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Francis EC, Powe CE, Lowe WL, White SL, Scholtens DM, Yang J, Zhu Y, Zhang C, Hivert MF, Kwak SH, Sweeting A. Refining the diagnosis of gestational diabetes mellitus: a systematic review and meta-analysis. COMMUNICATIONS MEDICINE 2023; 3:185. [PMID: 38110524 PMCID: PMC10728189 DOI: 10.1038/s43856-023-00393-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/25/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Perinatal outcomes vary for women with gestational diabetes mellitus (GDM). The precise factors beyond glycemic status that may refine GDM diagnosis remain unclear. We conducted a systematic review and meta-analysis of potential precision markers for GDM. METHODS Systematic literature searches were performed in PubMed and EMBASE from inception to March 2022 for studies comparing perinatal outcomes among women with GDM. We searched for precision markers in the following categories: maternal anthropometrics, clinical/sociocultural factors, non-glycemic biochemical markers, genetics/genomics or other -omics, and fetal biometry. We conducted post-hoc meta-analyses of a subset of studies with data on the association of maternal body mass index (BMI, kg/m2) with offspring macrosomia or large-for-gestational age (LGA). RESULTS A total of 5905 titles/abstracts were screened, 775 full-texts reviewed, and 137 studies synthesized. Maternal anthropometrics were the most frequent risk marker. Meta-analysis demonstrated that women with GDM and overweight/obesity vs. GDM with normal range BMI are at higher risk of offspring macrosomia (13 studies [n = 28,763]; odds ratio [OR] 2.65; 95% Confidence Interval [CI] 1.91, 3.68), and LGA (10 studies [n = 20,070]; OR 2.23; 95% CI 2.00, 2.49). Lipids and insulin resistance/secretion indices were the most studied non-glycemic biochemical markers, with increased triglycerides and insulin resistance generally associated with greater risk of offspring macrosomia or LGA. Studies evaluating other markers had inconsistent findings as to whether they could be used as precision markers. CONCLUSIONS Maternal overweight/obesity is associated with greater risk of offspring macrosomia or LGA in women with GDM. Pregnancy insulin resistance or hypertriglyceridemia may be useful in GDM risk stratification. Future studies examining non-glycemic biochemical, genetic, other -omic, or sociocultural precision markers among women with GDM are warranted.
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Affiliation(s)
- Ellen C Francis
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA.
| | - Camille E Powe
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - William L Lowe
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sara L White
- Department of Women and Children's Health, King's College London, London, UK
| | - Denise M Scholtens
- Department of Preventive Medicine, Division of Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jiaxi Yang
- Global Center for Asian Women's Health (GloW), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yeyi Zhu
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Cuilin Zhang
- Global Center for Asian Women's Health (GloW), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Bia-Echo Asia Centre for Reproductive Longevity & Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Marie-France Hivert
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Arianne Sweeting
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Tamargo JA, Strath LJ, Karanth SD, Spector AL, Sibille KT, Anton S, Cruz-Almeida Y. Food insecurity is associated with chronic pain and high-impact chronic pain in the USA. Public Health Nutr 2023; 27:e7. [PMID: 38087858 PMCID: PMC10830368 DOI: 10.1017/s1368980023002732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/08/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE This study evaluated whether food insecurity (US Adult Food Security Survey) was associated with chronic pain (≥ 3 months) and high-impact chronic pain (i.e. pain that limits work and life) among US adults. DESIGN Cross-sectional analysis. SETTING Nationally representative sample of non-institutionalised adults in the USA. PARTICIPANTS 79 686 adults from the National Health Interview Survey (2019-2021). RESULTS Marginal, low and very low food security were associated with increased prevalence odds of chronic pain (OR: 1·58 (95 % CI 1·44, 1·72), 2·28 (95 % CI 2·06, 2·52) and 3·37 (95 % CI 3·01, 3·78), respectively) and high-impact chronic pain (OR: 1·28 (95 % CI 1·14, 1·42), 1·55 (95 % CI 1·37, 1·75) and 1·90 (95 % CI 1·65, 2·18), respectively) in a dose-response fashion (P-trend < 0·0001 for both), adjusted for sociodemographic, socio-economic and clinically relevant factors. Participation in Supplemental Nutrition Assistance Program (SNAP) and age modified the association between food insecurity and chronic pain. CONCLUSIONS These findings illustrate the impact of socio-economic factors on chronic pain and suggest that food insecurity may be a social determinant of chronic pain. Further research is needed to better understand the complex relationship between food insecurity and chronic pain and to identify targets for interventions. Moreover, the consideration of food insecurity in the clinical assessment of pain and pain-related conditions among socio-economically disadvantaged adults may be warranted.
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Affiliation(s)
- Javier A Tamargo
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Institute on Aging, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Larissa J Strath
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Shama D Karanth
- University of Florida Health Cancer Center, University of Florida, Gainesville, FL, USA
| | - Antoinette L Spector
- College of Health Professions and Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Kimberly T Sibille
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Physical Medicine & Rehabilitation, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Stephen Anton
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Institute on Aging, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
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Amegbletor DY, Goldberg D, Pope DA, Heckman BW. Food and Nutrition Security as Social Determinants of Health: Fostering Collective Impact to Build Equity. Prim Care 2023; 50:633-644. [PMID: 37866836 DOI: 10.1016/j.pop.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
An overview of the state of the American diet, how it relates to public health outcomes and the obesity epidemic, and how it arises from the policy and infrastructure that have been developed over the course of the 20th and 21st centuries. The article concludes by laying out concrete solutions for urban revitalization, providing people in underserved communities sovereignty over their food supply, and work with multi-stakeholder cooperatives to overcome the effects of food insecurity and poor diet quality.
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Affiliation(s)
- Duncan Y Amegbletor
- Department of Psychiatry & Behavioral Sciences, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Boulevard, Nashville, TN 37208, USA
| | - Danny Goldberg
- Grow2Learn Cooperative, 445 Kemper Drive, North, Madison, TN 37115, USA
| | - Derek A Pope
- Department of Psychiatry & Behavioral Sciences, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Boulevard, Nashville, TN 37208, USA
| | - Bryan W Heckman
- Department of Psychiatry & Behavioral Sciences, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Boulevard, Nashville, TN 37208, USA; Division of Public Health, School of Graduate Studies and Research, Meharry Medical College, 1005 Dr. D.B. Todd, Jr. Boulevard, Nashville, TN 37208, USA.
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10
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Parks CA, Mitchell E, Byker Shanks C, Budd Nugent N, Reynolds M, Sun K, Zhang N, Yaroch AL. Which Program Implementation Factors Lead to more Fruit and Vegetable Purchases? An Exploratory Analysis of Nutrition Incentive Programs across the United States. Curr Dev Nutr 2023; 7:102040. [PMID: 38130331 PMCID: PMC10733675 DOI: 10.1016/j.cdnut.2023.102040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 12/23/2023] Open
Abstract
Background Nutrition incentive (NI) programs help low-income households better afford fruits and vegetables (FVs) by providing incentives to spend on FVs (e.g., spend $10 to receive an additional $10 for FVs). NI programs are heterogeneous in programmatic implementation and operate in food retail outlets, including brick-and-mortar and farm-direct sites. Objective This study aimed to explore NI program implementation factors and the amount of incentives redeemed. Methods A total of 28 NI projects across the United States including 487 brick-and-mortar and 1078 farm-direct sites reported data between 2020 and 2021. Descriptive statistics and linear regression analyses (outcome: incentives redeemed) were applied. Results Traditional brick-and-mortar stores had 0.48 times the incentives redeemed compared with small brick-and-mortar stores. At brick-and-mortar sites, automatic discounts had 3.47 times the incentives redeemed compared with physical discounts; and auxiliary services and marketing led to greater redemption. Farm-direct sites using multilingual and direct promotional marketing had greater incentives redeemed. Conclusions To our knowledge, this is the first national study to focus on NI program implementation across sites nationwide. Factors identified can help inform future programming and research.
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Affiliation(s)
| | - Elise Mitchell
- Gretchen Swanson Center for Nutrition, Omaha, NE United States
| | | | | | - Megan Reynolds
- Gretchen Swanson Center for Nutrition, Omaha, NE United States
| | - Kiki Sun
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Nanhua Zhang
- Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Amy L Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE United States
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11
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Lu I, Suss R, Lanza DV, Cohen S, Yusuf Y, Yi SS. A qualitative study to inform the development of a subsidized community-supported agriculture program for Chinese Americans in Brooklyn, New York, U.S. Prev Med Rep 2023; 36:102480. [PMID: 37920594 PMCID: PMC10618813 DOI: 10.1016/j.pmedr.2023.102480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 11/04/2023] Open
Abstract
The objective of this study was to inform the development of a subsidized, culturally adapted Community-Supported Agriculture (CSA) program for the Chinese American (CA) community in Brooklyn, New York (NY), USA. We conducted interviews with CA adults to understand their eating and shopping behaviors, interests in CSAs, and recommendations for educational content to inform the development of a subsidized and culturally adapted CSA. We then conducted thematic analysis of those interviews and identified major themes. CA adult participants shared interest in a CSA primarily to support their own health, interact socially with farmers and other participants, and gain access to fresh, culturally appropriate produce. Major concerns for participation, especially among older adults, included language barriers, transportation, and mobility. The unique needs and motivations of CAs should be centered in the development of alternative food access interventions for this population. CA adult participants living in Brooklyn, NY may be interested in a subsidized culturally adapted CSA that includes health information about the produce and provides in-language support. Engaging communities in the development of a health program may be important to ensure accessibility and acceptability for CA populations.
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Affiliation(s)
- Isabel Lu
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Rachel Suss
- Department Population Health, NYU Grossman School of Medicine, New York University Langone Health, United States
| | - Dalila Victoria Lanza
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, United States
| | - Sarah Cohen
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, United States
| | - Yousra Yusuf
- Department Population Health, NYU Grossman School of Medicine, New York University Langone Health, United States
| | - Stella S. Yi
- Department Population Health, NYU Grossman School of Medicine, New York University Langone Health, United States
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Smith MR, Bittner JMP, Loch LK, Haynes HE, Bloomer BF, Te-Vazquez J, Bowling AI, Brady SM, Tanofsky-Kraff M, Chen KY, Yanovski JA, Cheon BK. Independent and Interactive Associations of Subjective and Objective Socioeconomic Status With Body Composition and Parent-Reported Hyperphagia Among Children. Child Obes 2023. [PMID: 37943608 DOI: 10.1089/chi.2023.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Background: Subjective socioeconomic status (SSES) and objective socioeconomic status (OSES) have been independently associated with body composition and eating behavior in children. While low OSES may constrain access to healthier foods, low SSES has been associated with increased preference for and motivation to consume higher energy foods and portions independent of OSES. Despite these distinct ways that OSES and SSES may affect children's eating behavior and adiposity, their joint contributions remain unclear. We investigated the independent and interactive associations of SSES and OSES with children's BMI, fat mass index (FMI), and caregiver-reported hyperphagia. Methods: Data were derived from the Children's Growth and Behavior Study, an ongoing observational study. Multiple linear regressions used child's SSES and OSES of the family as independent factors and modeled the statistical interaction of SSES and OSES with BMI (n = 128), FMI (n = 122), and hyperphagia and its subscales (n = 76) as dependent variables. Results: SSES was independently and negatively associated with hyperphagia severity and OSES was independently and negatively associated with both FMI and hyperphagia severity. There was a statistical interaction effect of SSES and OSES on hyperphagia severity-lower SSES was associated with greater hyperphagia severity only at lower levels of OSES. Conclusions: These findings demonstrate a relationship between low OSES and child adiposity and that the relationship between child SSES and hyperphagia severity may be most relevant for children from households with lower family OSES. Future research on socioeconomic disparities in children's body composition and eating behaviors should examine the interaction of SSES and OSES. Clinical Trial Registration: NCT02390765.
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Affiliation(s)
- Meegan R Smith
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Julia M P Bittner
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Lucy K Loch
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Hannah E Haynes
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
- Military Cardiovascular Outcomes Research Program, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Metis Foundation, San Antonio, TX, USA
| | - Bess F Bloomer
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Te-Vazquez
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Andrea I Bowling
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Sheila M Brady
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Marian Tanofsky-Kraff
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Military Cardiovascular Outcomes Research Program, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Kong Y Chen
- Diabetes, Endocrinology, and Obesity Branch, Division of Intramural Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jack A Yanovski
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Bobby K Cheon
- Social and Behavioral Sciences Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Cordon IM, Doerr C, Whetstone L. California's Supplemental Nutrition Assistance Program-Education (SNAP-Ed) Be Better social marketing campaign: mothers' fruit and vegetable consumption and facilitation of children's healthy behaviours. Public Health Nutr 2023; 26:2514-2525. [PMID: 37424282 DOI: 10.1017/s1368980023001301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
OBJECTIVE Evaluation of California Department of Public Health's three-year social marketing campaign (Be Better) to encourage healthy eating and water consumption among Supplemental Nutrition Assistance Program-Education (SNAP-Ed) California mothers. Andreasen's social marketing framework was used to outline the development and evaluation of the campaign. DESIGN Quantitative, pre-post cross-sectional study with three cohorts nested within survey years. Generalised estimating equation modeling was used to obtain population estimates of campaign reach and changes in mothers' fruit and vegetable (FV) consumption and facilitative actions towards their children's health behaviours. SETTING CalFresh Healthy Living (California's SNAP-Ed). PARTICIPANTS Three separate cohorts of SNAP mothers were surveyed (pre, post) between 2016 and 2018 inclusive. A total of 2229 mothers (ages 18-59) self-identified as White, Latina, African American or Asian/Pacific Islander participated. RESULTS Approximately 82 percent of surveyed mothers were aware of the campaign as assessed by measures of recall and recognition. Ad awareness was positively associated with mothers' FV consumption (R2 = 0·45), with the proportion of FV on plates and with behaviours that facilitate children's FV consumption and limit unhealthy snacks and sugary drinks (βs ranged from 0·1 to 0·7). CONCLUSIONS The campaign successfully reached 82 percent of surveyed mothers. Positive associations between California's Be Better campaign and targeted health behaviours were observed, although the associations varied by year and media channel (i.e. television, radio, billboards and digital). Most associations between ad awareness and outcomes were noted in years two and three of the campaign, suggesting that more than 1 year of campaign exposure was necessary for associations to emerge.
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Affiliation(s)
- Ingrid M Cordon
- California Department of Public Health, Nutrition Education and Obesity Prevention Branch, 1616 Capitol Ave, Sacramento, CA95814, USA
| | - Celeste Doerr
- California Department of Public Health, Maternal, Child and Adolescent Health Division, 1615 Capitol Ave, Sacramento, CA95814, USA
| | - Lauren Whetstone
- California Department of Public Health, Nutrition Education and Obesity Prevention Branch, 1616 Capitol Ave, Sacramento, CA95814, USA
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14
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Caspi CE, Gombi-Vaca MF, Wolfson J, Harnack LJ, De Marco M, Pratt R, Durfee T, Myers SL. Early results of a natural experiment evaluating the effects of a local minimum wage policy on the diet-related health of low-wage workers, 2018-2020. Public Health Nutr 2023; 26:2573-2585. [PMID: 37548177 PMCID: PMC10641626 DOI: 10.1017/s1368980023001520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 06/20/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE The current study presents results of a midpoint analysis of an ongoing natural experiment evaluating the diet-related effects of the Minneapolis Minimum Wage Ordinance, which incrementally increases the minimum wage to $15/h. DESIGN A difference-in-difference (DiD) analysis of measures collected among low-wage workers in two U.S. cities (one city with a wage increase policy and one comparison city). Measures included employment-related variables (hourly wage, hours worked and non-employment assessed by survey questions with wages verified by paystubs), BMI measured by study scales and stadiometers and diet-related mediators (food insecurity, Supplemental Nutrition Assistance Program (SNAP) participation and daily servings of fruits and vegetables, whole-grain rich foods and foods high in added sugars measured by survey questions). SETTING Minneapolis, Minnesota and Raleigh, North Carolina. PARTICIPANTS A cohort of 580 low-wage workers (268 in Minneapolis and 312 in Raleigh) who completed three annual study visits between 2018 and 2020. RESULTS In DiD models adjusted for time-varying and non-time-varying confounders, there were no statistically significant differences in variables of interest in Minneapolis compared with Raleigh. Trends across both cities were evident, showing a steady increase in hourly wage, stable BMI, an overall decrease in food insecurity and non-linear trends in employment, hours worked, SNAP participation and dietary outcomes. CONCLUSION There was no evidence of a beneficial or adverse effect of the Minimum Wage Ordinance on health-related variables during a period of economic and social change. The COVID-19 pandemic and other contextual factors likely contributed to the observed trends in both cities.
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Affiliation(s)
- Caitlin E Caspi
- Rudd Center for Food Policy and Health, University of Connecticut, 1 Constitution Plaza, Hartford, CT061032, USA
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Dr., Storrs, CT06269, USA
| | - Maria Fernanda Gombi-Vaca
- Rudd Center for Food Policy and Health, University of Connecticut, 1 Constitution Plaza, Hartford, CT061032, USA
| | - Julian Wolfson
- Division of Biostatistics, School of Public Health, University of Minnesota, A460 Mayo Building MMC 303, 425 Delaware St. SE, Minneapolis, MN, USA
| | - Lisa J Harnack
- Division of Epidemiology and Community Health, Suite 300, University of Minnesota, 1300 South 2nd St, Minneapolis, MN, USA
| | - Molly De Marco
- Center for Health Promotion & Disease Prevention, University of North Carolina at Chapel Hill, 1700 M.L.K. Jr Blvd #7426, Chapel Hill, NC27514, USA
- Department of Nutrition, Gillings School of Global Public Health, UNC-CH, 135 Dauer Dr, Chapel Hill, NC27599, USA
| | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware St. se, Minneapolis, MN55445, USA
| | - Thomas Durfee
- The Roy Wilkins Center for Human Relations and Social Justice, Hubert H. Humphrey School of Public Affairs, University of Minnesota, 270 Humphrey Center, 301 19th Avenue South, Minneapolis, MN, USA
- Department of Applied Economics, University of Minnesota, 231 Ruttan Hall, 1994 Buford Avenue, St. Paul, MN, USA
| | - Samuel L. Myers
- The Roy Wilkins Center for Human Relations and Social Justice, Hubert H. Humphrey School of Public Affairs, University of Minnesota, 270 Humphrey Center, 301 19th Avenue South, Minneapolis, MN, USA
- Department of Applied Economics, University of Minnesota, 231 Ruttan Hall, 1994 Buford Avenue, St. Paul, MN, USA
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15
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Folta SC, Li Z, Cash SB, Hager K, Zhang FF. Adoption and implementation of produce prescription programs for under-resourced populations: clinic staff perspectives. Front Nutr 2023; 10:1221785. [PMID: 37964933 PMCID: PMC10641783 DOI: 10.3389/fnut.2023.1221785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
Background Produce prescription programs represent a promising intervention strategy in the healthcare setting to address disparities in diet quality and diet-related chronic disease. The objective of this study was to understand adoption and implementation factors related to these programs that are common across contexts and those that are context-specific. Methods In this qualitative case comparison study, we conducted qualitative interviews with eight clinic staff from five primary care "safety net" clinics, identified by a partnering non-profit organization that operated the programs, in April-July 2021. Results Across clinics, the ability to provide a tangible benefit to patients was a key factor in adoption. Flexibility in integrating into clinic workflows was a facilitator of implementation. Fit with usual operations varied across clinics. Common challenges were the need for changes to the workflow and extra staff time. Clinic staff were skeptical about the sustainability of both the benefits to patients and the ability to continue the program at their clinics. Discussion This study adds to a growing body of knowledge on the adoption and implementation of produce prescription programs. Future research will further this understanding, providing the evidence necessary to guide adopting clinics and to make informed policy decisions to best promote the growth and financial sustainability of these programs.
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Affiliation(s)
- Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
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16
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Oleschuk BM, Choi HY, Ellison B, Pflugh Prescott M. Associations between cooking self-efficacy, attitude, and behaviors among people living alone: A cross-sectional survey analysis. Appetite 2023; 189:106999. [PMID: 37562756 DOI: 10.1016/j.appet.2023.106999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023]
Abstract
Cooking-related literacy and attitudes may play important roles in preventing and reducing diet-related chronic diseases and nutrition disparities. People living alone are an under-researched but growing population who face above average food insecurity rates. This study's objectives were to 1) test how cooking self-efficacy and attitude are stratified demographically among a sample of people living alone, focusing on variations across gender, age, and food security, and 2) examine how cooking self-efficacy and attitude are associated with two indicators of cooking behavior - cooking frequency and convenience orientation. We draw from a cross-sectional survey analysis of 493 adults living alone in Illinois, USA with validated measures for cooking self-efficacy, attitude, frequency, convenience orientation, and demographic characteristics. Hierarchical linear regression models were used to examine demographic factors explaining variation in self-efficacy and attitude, with attention to interactions between gender, food insecurity, and age. Poisson and OLS linear regression models were used to examine associations between self-efficacy and attitude and cooking frequency and convenience orientation. We find cooking-related self-efficacy and attitude showed strong but distinct associations with cooking frequency and convenience orientation. Overall, food insecure groups had lower self-efficacy than those who were food secure; however, food insecure women had higher self-efficacy than men in similar positions, apart from older-adult women who held particularly low efficacy. Cooking attitudes varied in small ways, notably with food insecure younger and older women possessing more negative cooking attitudes than middle-aged women. This research highlights the importance of understanding the cooking-related orientations of single-living people, while demonstrating that this group's ability to prevent and manage food insecurity is not uniform. These results can inform targeted interventions around food and nutrition insecurity, cooking attitudes, and self-efficacy among single-living populations.
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Affiliation(s)
- By Merin Oleschuk
- Department of Human Development and Family Studies, University of Illinois Urbana-Champaign, 2015 Doris Kelley Christopher Hall, 904 W Nevada St., Urbana, IL, 61801, USA.
| | - Ha Young Choi
- Department of Human Development and Family Studies, University of Illinois Urbana-Champaign, 2015 Doris Kelley Christopher Hall, 904 W Nevada St., Urbana, IL, 61801, USA
| | - Brenna Ellison
- Department of Agricultural Economics, Purdue University, 403 W. State Street, West Lafayette, IN, 47907, USA
| | - Melissa Pflugh Prescott
- Department of Food Science and Human Nutrition, University of Illinois Urbana-Champaign, 905 S. Goodwin Ave, Urbana, 61801, USA
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17
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Zhang K, Han Y, Gu Z, Hou Z, Yu X, Gao M, Cai T, Gao Y, Xie J, Gu F, Chen J, Chen B, Liu T. Association between dietary vitamin E intake and cognitive decline among old American: National Health and Nutrition Examination Survey. Eur Geriatr Med 2023; 14:1027-1036. [PMID: 37615806 DOI: 10.1007/s41999-023-00814-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/05/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE Numerous studies have reported that vitamin E plays a key role in nervous system development and neurotransmitter production. This study aimed to investigate changes in vitamin E intake in older adults with low cognitive performance using NHANES. METHODS In this cross-sectional study, we examined a sample of 2255 American adults aged 60 and over between 2011 and 2014. We collected dietary data by averaging two recalls for dietary use to determine vitamin E intake. We assessed cognitive function using five tests and analyzed the association between these variables using a multivariate logistic regression model. RESULTS A total of 2255 participants aged ≥ 60 years from the National Health and Nutrition Examination Survey (NHANES) for the 2011-2014 cycle were included in the analysis. Vitamin E intake was negatively associated with cognitive function. In the Z test, with each 1 mg/day increase in dietary intake of vitamin E, there was a 6% decrease in the correlation with cognitive impairment (OR = 0.94, 95% CI 0.91-0.97) in the fully fitted model (OR = 0.94, 95% CI 0.91-0.97). These findings remained consistent when analyzing the exposure as a categorical variable. In comparison to Q1, Q4 showed a 53% reduction in the incidence of cognitive impairment in the Z test (OR = 0.47, 95% CI 0.33-0.67).No significant statistical interaction between the variables was found. CONCLUSION An increased dietary intake of vitamin E has been associated with decreased cognitive impairment in individuals over 60 years old. The dose-response curve showed an L-shaped association between dietary vitamin E intake and cognitive decline in US adults, with an inflection point of approximately 9.296 mg/day.
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Affiliation(s)
- Kai Zhang
- The Second Hospital, Jilin University, No. 218, Ziqiang Street, Changchun, Jilin, China.
| | - Yu Han
- Department of Ophthalmology, First Hospital of Jilin University, No.71 Xinmin Street, Changchun, Jilin, China
| | - Zhaoxuan Gu
- The Second Hospital, Jilin University, No. 218, Ziqiang Street, Changchun, Jilin, China
| | - Zhengyan Hou
- Bethune Second School of Clinical Medicine, Jilin University, No.828 Xinmin Street, Changchun, Jilin, China
| | - Xiaoqi Yu
- Bethune Second School of Clinical Medicine, Jilin University, No.828 Xinmin Street, Changchun, Jilin, China
| | - Min Gao
- Bethune Second School of Clinical Medicine, Jilin University, No.828 Xinmin Street, Changchun, Jilin, China
| | - Tianyi Cai
- Bethune Second School of Clinical Medicine, Jilin University, No.828 Xinmin Street, Changchun, Jilin, China
| | - Yafang Gao
- Bethune Second School of Clinical Medicine, Jilin University, No.828 Xinmin Street, Changchun, Jilin, China
| | - Jinyu Xie
- Bethune Second School of Clinical Medicine, Jilin University, No.828 Xinmin Street, Changchun, Jilin, China
| | - Fangming Gu
- Bethune Second School of Clinical Medicine, Jilin University, No.828 Xinmin Street, Changchun, Jilin, China
| | - Jianguo Chen
- Bethune First College of Clinical Medicine, Jilin University, No.828 Xinmin Street, Changchun, Jilin, China
| | - Bowen Chen
- Bethune First College of Clinical Medicine, Jilin University, No.828 Xinmin Street, Changchun, Jilin, China
| | - Tianzhou Liu
- Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital, Jilin University, No. 218, Ziqiang Street, Changchun, Jilin, China.
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18
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Zhang K, Han Y, Gu F, Gu Z, Zhao J, Chen J, Chen B, Gao M, Hou Z, Yu X, Cai T, Gao Y, Hu R, Xie J, Liu T. Association between dietary zinc intake and Helicobacter pylori seropositivity in US adults: National Health and Nutrition Examination Survey. Front Nutr 2023; 10:1243908. [PMID: 37810930 PMCID: PMC10551451 DOI: 10.3389/fnut.2023.1243908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Purpose Helicobacter pylori infection is a well-established etiological factor for gastric inflammation and a significant risk factor for the development of gastric cancer. However, the precise relationship between dietary zinc intake and seropositivity for Helicobacter pylori remains uncertain. Methods This cross-sectional observational study utilized data from the United States National Health and Nutrition Examination Survey conducted between 1999 and 2000. The study cohort comprised 2,884 adults aged 20 years or older who provided comprehensive 24-h dietary recall data. The presence of Helicobacter pylori infection was confirmed using serum analysis and lgG protein enzyme-linked immunosorbent assay (ELISA). Multivariable logistic regression models and generalized additive model (GAM) were employed to explore the potential association between dietary zinc intake and Helicobacter pylori seropositivity. Results Additionally, subgroup analysis was performed to evaluate the robustness of the primary findings. Of the 1,281 participants, 47.8% were male and the average age was 49.5 years. In the fully adjusted model, a statistically significant inverse association between dietary zinc intake and Helicobacter pylori seropositivity was observed [quartile variable, Q4 vs. Q1, odds ratio (OR): 0.72, 95% confidence interval (CI): 0.57-0.91, p = 0.007]. Furthermore, the relationship between dietary zinc intake and Helicobacter pylori seropositivity exhibited an L-shaped pattern, indicating a saturation effect. The results of sensitivity analysis remained consistent and reliable. Conclusion Therefore, this study suggests that higher dietary zinc intake may be associated with a lower prevalence of Helicobacter pylori seropositivity. Notably, this association follows an L-shaped pattern, with a threshold point estimated at 24.925 mg/day.
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Affiliation(s)
- Kai Zhang
- Department of Cardiovascular Surgery, Second Hospital of Jilin University, Changchun, China
| | - Yu Han
- Department of Ophthalmology, First Hospital of Jilin University, Changchun, China
| | - Fangming Gu
- Department of Cardiovascular Surgery, Second Hospital of Jilin University, Changchun, China
| | - Zhaoxuan Gu
- Department of Cardiovascular Surgery, Second Hospital of Jilin University, Changchun, China
| | - JiaYu Zhao
- Department of Cardiovascular Surgery, Second Hospital of Jilin University, Changchun, China
| | - Jianguo Chen
- Bethune First College of Clinical Medicine, Jilin University, Changchun, China
| | - Bowen Chen
- Bethune First College of Clinical Medicine, Jilin University, Changchun, China
| | - Min Gao
- Department of Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Zhengyan Hou
- Bethune Second School of Clinical Medicine, Jilin University, Changchun, China
| | - Xiaoqi Yu
- Bethune Second School of Clinical Medicine, Jilin University, Changchun, China
| | - Tianyi Cai
- Department of Cardiovascular Surgery, Second Hospital of Jilin University, Changchun, China
| | - Yafang Gao
- Bethune Second School of Clinical Medicine, Jilin University, Changchun, China
| | - Rui Hu
- Bethune Third College of Clinical Medicine, Jilin University, Changchun, China
| | - Jinyu Xie
- Bethune Second School of Clinical Medicine, Jilin University, Changchun, China
| | - Tianzhou Liu
- Department of Gastrointestinal Surgery, The Second Hospital of Jilin University, Changchun, China
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Singleton CR, Wright LA, McDonald M, Archer IG, Bell CN, McLoughlin GM, Houghtaling B, Cooksey Stowers K, Anderson Steeves E. Structural racism and geographic access to food retailers in the United States: A scoping review. Health Place 2023; 83:103089. [PMID: 37557002 DOI: 10.1016/j.healthplace.2023.103089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/16/2023] [Accepted: 07/17/2023] [Indexed: 08/11/2023]
Abstract
This scoping review summarized findings and key measures from U.S.-based studies that 1) examined associations between geographic indicators of structural racism (e.g., redlining, racial segregation) and access to food retailers (e.g., supermarkets, convenience stores) or 2) documented disparities in access by neighborhood racial/ethnic composition. In 2022, relevant scientific literature was reviewed using Covidence software. Independent reviewers examined 13,069 citations; 163 citations advanced to the full-text review stage and 70 were selected for inclusion. Twenty-one studies (30%) linked one or more indicator of structural racism to food retailer access while 49 (70%) solely examined differences in access by neighborhood racial/ethnic composition. All studies featuring indicators of structural racism reported significant findings; however, indicators varied across studies making it difficult to make direct comparisons. Key indicators of structural racism in the food access literature included redlining (n = 3), gentrification (n = 3), and racial segregation (n = 4). Many U.S.-based studies have evaluated food retailer access by neighborhood racial/ethnic composition. Moving forward, studies should model indicators of structural racism and determine their influence on geographic access to large and small food retailers.
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Affiliation(s)
- Chelsea R Singleton
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, LA, USA.
| | - Laura A Wright
- Rudolph Matas Library of the Health Sciences, Tulane University, New Orleans, LA, USA
| | - Meredith McDonald
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Isabel G Archer
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Caryn N Bell
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, LA, USA
| | - Gabriella M McLoughlin
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA; Implementation Science Center for Cancer Control, Washington University in St. Louis, St. Louis, MO, USA
| | - Bailey Houghtaling
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA; Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - Kristen Cooksey Stowers
- Department of Allied Health Sciences, College of Agriculture, Health, And Natural Resources, University of Connecticut, Storrs, CT, USA
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20
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Hager K, Du M, Li Z, Mozaffarian D, Chui K, Shi P, Ling B, Cash SB, Folta SC, Zhang FF. Impact of Produce Prescriptions on Diet, Food Security, and Cardiometabolic Health Outcomes: A Multisite Evaluation of 9 Produce Prescription Programs in the United States. Circ Cardiovasc Qual Outcomes 2023; 16:e009520. [PMID: 37641928 PMCID: PMC10529680 DOI: 10.1161/circoutcomes.122.009520] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 06/14/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Produce prescriptions may improve cardiometabolic health by increasing fruit and vegetable (F&V) consumption and food insecurity yet impacts on clinical outcomes and health status have not been evaluated in large, multisite evaluations. METHODS This multisite, pre- and post-evaluation used individual-level data from 22 produce prescription locations in 12 US states from 2014 to 2020. No programs were previously evaluated. The study included 3881 individuals (2064 adults aged 18+ years and 1817 children aged 2-17 years) with, or at risk for, poor cardiometabolic health recruited from clinics serving low-income neighborhoods. Programs provided financial incentives to purchase F&V at grocery stores or farmers markets (median, $63/months; duration, 4-10 months). Surveys assessed F&V intake, food security, and self-reported health; glycated hemoglobin, blood pressure, body mass index (BMI), and BMI z-score were measured at clinics. Adjusted, multilevel mixed models accounted for clustering by program. RESULTS After a median participation of 6.0 months, F&V intake increased by 0.85 (95% CI, 0.68-1.02) and 0.26 (95% CI, 0.06-0.45) cups per day among adults and children, respectively. The odds of being food insecure dropped by one-third (odds ratio, 0.63 [0.52-0.76]) and odds of improving 1 level in self-reported health status increased for adults (odds ratio, 1.62 [1.30-2.02]) and children (odds ratio, 2.37 [1.70-3.31]). Among adults with glycated hemoglobin ≥6.5%, glycated hemoglobin declined by -0.29% age points (-0.42 to -0.16); among adults with hypertension, systolic and diastolic blood pressures declined by -8.38 mm Hg (-10.13 to -6.62) and -4.94 mm Hg (-5.96 to -3.92); and among adults with overweight or obesity, BMI decreased by -0.36 kg/m2 (-0.64 to -0.09). Child BMI z-score did not change -0.01 (-0.06 to 0.04). CONCLUSIONS In this large, multisite evaluation, produce prescriptions were associated with significant improvements in F&V intake, food security, and health status for adults and children, and clinically relevant improvements in glycated hemoglobin, blood pressure, and BMI for adults with poor cardiometabolic health.
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Affiliation(s)
- Kurt Hager
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Mengxi Du
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Zhongyu Li
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
- Tufts University School of Medicine, Boston, MA
- Division of Cardiology at Tufts Medical Center, Boston, MA
| | - Kenneth Chui
- Division of Cardiology at Tufts Medical Center, Boston, MA
| | - Peilin Shi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | | | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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21
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Conrad Z, Drewnowski A, Love DC. Greater adherence to the Dietary Guidelines for Americans is associated with lower diet-related greenhouse gas emissions but higher costs. Front Nutr 2023; 10:1220016. [PMID: 37599695 PMCID: PMC10433380 DOI: 10.3389/fnut.2023.1220016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Few studies have evaluated the sustainability of popular diet patterns in the US, which limits policy action and impedes consumer efficacy to make sustainable dietary changes. This study filled this gap by evaluating the relationship between diet quality, greenhouse gas emissions (GHGE), and diet cost for plant-based, restricted carbohydrate, low grain, low fat, and time restricted diet patterns. Methods Dietary data were retrieved from the National Health and Nutrition Examination Survey (2011-2018, n = 8,146) and linked with data on GHGE and food prices from publicly available databases. Diet quality was measured using the Healthy Eating Index-2015. The present study (1) compared the mean diet quality, GHGE, and diet cost between diet patterns, (2) evaluated the association of diet quality to GHGE and diet cost for each diet pattern, and (3) estimated the contribution of food sources to GHGE and diet cost for each diet pattern. Results Higher diet quality was associated with lower GHGE for the general population and for most diet patterns (p < 0.01) except for the plant-based and time restricted diet patterns (p > 0.05). Higher diet quality was associated with higher cost for the general population and for all dietary patterns (p < 0.01) except the time restricted diet pattern (p > 0.05). Protein foods, mostly beef, accounted for the largest share of GHGE (29-40%) and diet cost (28-47%) for all diet patterns except plant-based. Discussion Higher diet quality was associated with lower GHGE but was often accompanied by higher diet cost. These sustainability trade-offs can help inform major policy discussions in the US and shed light on further research needs in the area of food systems transformation.
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Affiliation(s)
- Zach Conrad
- Department of Kinesiology, William & Mary, Williamsburg, VA, United States
- Global Research Institute, William & Mary, Williamsburg, VA, United States
| | - Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, WA, United States
| | - David C. Love
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
- Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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22
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Wang L, Lauren BN, Hager K, Zhang FF, Wong JB, Kim DD, Mozaffarian D. Health and Economic Impacts of Implementing Produce Prescription Programs for Diabetes in the United States: A Microsimulation Study. J Am Heart Assoc 2023; 12:e029215. [PMID: 37417296 PMCID: PMC10492976 DOI: 10.1161/jaha.122.029215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/31/2023] [Indexed: 07/08/2023]
Abstract
Background Produce prescription programs, providing free or discounted produce and nutrition education to patients with diet-related conditions within health care systems, have been shown to improve dietary quality and cardiometabolic risk factors. The potential impact of implementing produce prescription programs for patients with diabetes on long-term health gains, costs, and cost-effectiveness in the United States has not been established. Methods and Results We used a validated state-transition microsimulation model (Diabetes, Obesity, Cardiovascular Disease Microsimulation model), populated with national data of eligible individuals from the National Health and Nutrition Examination Survey 2013 to 2018, further incorporating estimated intervention effects and diet-disease effects from meta-analyses, and policy- and health-related costs from published literature. The model estimated that over a lifetime (mean=25 years), implementing produce prescriptions in 6.5 million US adults with both diabetes and food insecurity (lifetime treatment) would prevent 292 000 (95% uncertainty interval, 143 000-440 000) cardiovascular disease events, generate 260 000 (110000-411 000) quality-adjusted life-years, cost $44.3 billion in implementation costs, and save $39.6 billion ($20.5-58.6 billion) in health care costs and $4.8 billion ($1.84-$7.70 billion) in productivity costs. The program was highly cost effective from a health care perspective (incremental cost-effectiveness ratio: $18 100/quality-adjusted life-years) and cost saving from a societal perspective (net savings: $-0.05 billion). The intervention remained cost effective at shorter time horizons of 5 and 10 years. Results were similar in population subgroups by age, race or ethnicity, education, and baseline insurance status. Conclusions Our model suggests that implementing produce prescriptions among US adults with diabetes and food insecurity would generate substantial health gains and be highly cost effective.
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Affiliation(s)
- Lu Wang
- The Gerald J. and Dorothy R. Friedman School of Nutrition Science and PolicyTufts UniversityBostonMAUSA
| | - Brianna N. Lauren
- The Gerald J. and Dorothy R. Friedman School of Nutrition Science and PolicyTufts UniversityBostonMAUSA
| | - Kurt Hager
- The Gerald J. and Dorothy R. Friedman School of Nutrition Science and PolicyTufts UniversityBostonMAUSA
| | - Fang Fang Zhang
- The Gerald J. and Dorothy R. Friedman School of Nutrition Science and PolicyTufts UniversityBostonMAUSA
| | - John B. Wong
- Division of Clinical Decision MakingTufts Medical CenterBostonMAUSA
| | - David D. Kim
- Division of Hospital Medicine, Department of MedicineUniversity of ChicagoILUSA
| | - Dariush Mozaffarian
- The Gerald J. and Dorothy R. Friedman School of Nutrition Science and PolicyTufts UniversityBostonMAUSA
- Division of CardiologyTufts Medical CenterBostonMAUSA
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23
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Abstract
Poor nutrition is the leading cause of poor health, health care spending, and lost productivity in the United States and globally, which acts through cardiometabolic diseases as precursors to cardiovascular disease, cancer, and other conditions. There is great interest in how the social determinants of health (the conditions in which people are born, live, work, develop, and age) impact cardiometabolic disease. Food insecurity is an example of a powerful social determinant of health that impacts health outcomes. Nutrition insecurity, a distinct but related concept to food insecurity, is a direct determinant of health. In this article, we provide an overview of how diet in early life relates to cardiometabolic disease and then continue to focus on the concepts of food insecurity and nutrition insecurity. In the discussions herein we make important distinctions between the concepts of food insecurity and nutrition insecurity and provide a review of their concepts, histories, measurement and assessment devices, trends and prevalence, and links to health and health disparities. The discussions here set the stage for future research and practice to directly address the negative consequences of food and nutrition insecurity.
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Affiliation(s)
- Eric J Brandt
- Division of Cardiovascular Medicine, Department of Internal Medicine (E.J.B., V.L.M.), University of Michigan, Ann Arbor, MI
- Institute for Healthcare Policy and Innovation (E.J.B.), University of Michigan, Ann Arbor, MI
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA (D.M.)
| | - Cindy W Leung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA (C.W.L.)
| | - Seth A Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine (S.A.B.)
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine (E.J.B., V.L.M.), University of Michigan, Ann Arbor, MI
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24
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Hager K, Shi P, Li Z, Chui K, Berkowitz SA, Mozaffarian D, Chhabra J, Wilken J, Vergara C, Becker E, Small S, Ling B, Cash SB, Folta SC, Zhang FF. Evaluation of a Produce Prescription Program for Patients With Diabetes: A Longitudinal Analysis of Glycemic Control. Diabetes Care 2023; 46:1169-1176. [PMID: 36812470 PMCID: PMC10234740 DOI: 10.2337/dc22-1645] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/27/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Produce prescriptions have shown promise in improving diabetes care, although most studies have used small samples or lacked controls. Our objective was to evaluate the impacts of a produce prescription program on glycemic control for patients with diabetes. RESEARCH DESIGN AND METHODS Participants included a nonrandom enrollment of 252 patients with diabetes who received a produce prescription and 534 similar control participants from two clinics in Hartford, Connecticut. The start of the COVID-19 pandemic in March 2020 coincided with program implementation. Produce prescription enrollees received vouchers ($60 per month) for 6 months to purchase produce at grocery retail. Controls received usual care. The primary outcome was change in glycated hemoglobin (HbA1c) between treatment and control at 6 months. Secondary outcomes included 6-month changes in systolic (SBP) and diastolic blood pressure (DBP), BMI, hospitalizations, and emergency department admissions. Longitudinal generalized estimating equation models, weighted with propensity score overlap weights, assessed changes in outcomes over time. RESULTS At 6 months, there was no significant difference in change in HbA1c between treatment and control groups, with a difference of 0.13 percentage points (95% CI -0.05, 0.32). No significant difference was observed for change in SBP (3.85 mmHg; -0.12, 7.82), DBP (-0.82 mmHg; -2.42, 0.79), or BMI (-0.22 kg/m2; -1.83, 1.38). Incidence rate ratios for hospitalizations and emergency department visits were 0.54 (0.14, 1.95) and 0.53 (0.06, 4.72), respectively. CONCLUSIONS A 6-month produce prescription program for patients with diabetes, implemented during the onset of the COVID-19 pandemic, was not associated with improved glycemic control.
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Affiliation(s)
- Kurt Hager
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Peilin Shi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Zhongyu Li
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Kenneth Chui
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA
| | - Seth A. Berkowitz
- Division of General Medicine and Clinical Epidemiology, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
- Tufts University School of Medicine, Boston, MA
- Division of Cardiology, Tufts Medical Center, Boston, MA
| | | | | | - Cunegundo Vergara
- Hartford Healthcare, Hartford, CT
- University of Connecticut (UConn) Internal Medicine Residency Program, UConn Health Center, Farmington, CT
| | | | | | | | - Sean B. Cash
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Sara C. Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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25
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Velarde G, Bravo‐Jaimes K, Brandt EJ, Wang D, Douglass P, Castellanos LR, Rodriguez F, Palaniappan L, Ibebuogu U, Bond R, Ferdinand K, Lundberg G, Thamman R, Vijayaraghavan K, Watson K. Locking the Revolving Door: Racial Disparities in Cardiovascular Disease. J Am Heart Assoc 2023; 12:e025271. [PMID: 36942617 PMCID: PMC10227271 DOI: 10.1161/jaha.122.025271] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Racial disparities in cardiovascular disease are unjust, systematic, and preventable. Social determinants are a primary cause of health disparities, and these include factors such as structural and overt racism. Despite a number of efforts implemented over the past several decades, disparities in cardiovascular disease care and outcomes persist, pervading more the outpatient rather than the inpatient setting, thus putting racial and ethnic minority groups at risk for hospital readmissions. In this article, we discuss differences in care and outcomes of racial and ethnic minority groups in both of these settings through a review of registries. Furthermore, we explore potential factors that connote a revolving door phenomenon for those whose adverse outpatient environment puts them at risk for hospital readmissions. Additionally, we review promising strategies, as well as actionable items at the policy, clinical, and educational levels aimed at locking this revolving door.
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Affiliation(s)
- Gladys Velarde
- Department of CardiologyUniversity of FloridaJacksonvilleFL
| | | | | | - Daniel Wang
- Division of CardiologyUniversity of CaliforniaLos AngelesCA
| | - Paul Douglass
- Division of CardiologyWellstar Atlanta Medical CenterAtlantaGA
| | | | - Fatima Rodriguez
- Division of Cardiology and the Cardiovascular InstituteStanford University School of MedicinePalo AltoCA
| | | | - Uzoma Ibebuogu
- Division of CardiologyUniversity of Tennessee Health Science CenterMemphisTN
| | - Rachel Bond
- Division of CardiologyDignity HealthGilbertAZ
- Division Cardiology, Department of Internal MedicineCreighton University School of MedicineOmahaNE
| | - Keith Ferdinand
- Division of CardiologyTulane School of MedicineNew OrleansLA
| | | | - Ritu Thamman
- Division of CardiologyUniversity of PittsburghPittsburghPA
| | | | - Karol Watson
- Division of CardiologyUniversity of CaliforniaLos AngelesCA
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26
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Rummo PE, Roberto CA, Thorpe LE, Troxel AB, Elbel B. Effect of Financial Incentives and Default Options on Food Choices of Adults With Low Income in Online Retail Settings: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e232371. [PMID: 36897592 PMCID: PMC10789116 DOI: 10.1001/jamanetworkopen.2023.2371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Importance Despite recent growth in online redemption of Supplemental Nutrition Assistance Program (SNAP) benefits, no previous work has tested the impact of economic and behavioral economic strategies on food purchasing behaviors in an online grocery retail setting among adults with low income. Objective To examine the extent to which financial incentives and default shopping cart options influence fruit and vegetable purchases. Design, Setting, and Participants This randomized clinical trial used an experimental online grocery store for adults who currently or have ever received SNAP benefits. From October 7 to December 2, 2021, participants were instructed to shop for a week's worth of groceries for their household, with a budget tailored to household size; no payment was taken. Interventions Random assignment to 1 of 4 conditions: no intervention, 50% discount on eligible fruits and vegetables, prefilled shopping carts with tailored fruit and vegetable items (ie, default options), or a combination of the discount and default options. Main Outcomes and Measures The primary outcome was the percentage of nondiscounted dollars spent on eligible fruit and vegetables per basket. Results Of 2744 participants, mean (SD) age was 46.7 (16.0) years, and 1447 (52.7%) identified as women. A total of 1842 participants (67.1%) reported currently receiving SNAP benefits and 1492 (54.4%) reported shopping online for groceries in the previous 12 months. Participants spent a mean (SD) 20.5% (23.5%) of total dollars on eligible fruits and vegetables. Compared with no intervention, those in the discount condition spent 4.7% (98.3% CI, 1.7%-7.7%) of more total dollars on eligible fruits and vegetables; those in the default condition, 7.8% (98.3% CI, 4.8%-10.7%) more; and those in the combination condition, 13.0% (98.3% CI, 10.0%-16.0%) more (P < .001 for all). There was no difference between the discount and the default conditions (P = .06), but the effect in the combination condition was significantly larger than both discount and default conditions (P < .001). Default shopping cart items were purchased by 679 participants (93.4%) in the default condition and 655 (95.5%) in the combination condition, whereas 297 (45.8%) in the control and 361 (52.9%) in the discount conditions purchased those items (P < .001). No variation was observed by age, sex, or race and ethnicity, and results were similar when those who reported never shopping online for groceries were excluded. Conclusions and Relevance In this randomized clinical trial, financial incentives for fruits and vegetables and default options, especially in combination, led to meaningful increases in online fruit and vegetable purchases among adults with low income. Trial Registration ClinicalTrials.gov Identifier: NCT04766034.
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Affiliation(s)
- Pasquale E. Rummo
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | | | - Lorna E. Thorpe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Andrea B. Troxel
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Brian Elbel
- Department of Population Health, New York University Grossman School of Medicine, New York, NY
- Wagner Graduate School of Public Service, New York University, New York, NY
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Schillinger D, Bullock A, Powell C, Fukagawa NK, Greenlee MC, Towne J, Gonzalvo JD, Lopata AM, Cook JW, Herman WH. The National Clinical Care Commission Report to Congress: Leveraging Federal Policies and Programs for Population-Level Diabetes Prevention and Control: Recommendations From the National Clinical Care Commission. Diabetes Care 2023; 46:e24-e38. [PMID: 36701595 PMCID: PMC9887620 DOI: 10.2337/dc22-0619] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/04/2022] [Indexed: 01/27/2023]
Abstract
The etiology of type 2 diabetes is rooted in a myriad of factors and exposures at individual, community, and societal levels, many of which also affect the control of type 1 and type 2 diabetes. Not only do such factors impact risk and treatment at the time of diagnosis but they also can accumulate biologically from preconception, in utero, and across the life course. These factors include inadequate nutritional quality, poor access to physical activity resources, chronic stress (e.g., adverse childhood experiences, racism, and poverty), and exposures to environmental toxins. The National Clinical Care Commission (NCCC) concluded that the diabetes epidemic cannot be treated solely as a biomedical problem but must also be treated as a societal problem that requires an all-of-government approach. The NCCC determined that it is critical to design, leverage, and coordinate federal policies and programs to foster social and environmental conditions that facilitate the prevention and treatment of diabetes. This article reviews the rationale, scientific evidence base, and content of the NCCC's population-wide recommendations that address food systems; consumption of water over sugar-sweetened beverages; food and beverage labeling; marketing and advertising; workplace, ambient, and built environments; and research. Recommendations relate to specific federal policies, programs, agencies, and departments, including the U.S. Department of Agriculture, the Food and Drug Administration, the Federal Trade Commission, the Department of Housing and Urban Development, the Environmental Protection Agency, and others. These population-level recommendations are transformative. By recommending health-in-all-policies and an equity-based approach to governance, the NCCC Report to Congress has the potential to contribute to meaningful change across the diabetes continuum and beyond. Adopting these recommendations could significantly reduce diabetes incidence, complications, costs, and inequities. Substantial political resolve will be needed to translate recommendations into policy. Engagement by diverse members of the diabetes stakeholder community will be critical to such efforts.
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Affiliation(s)
- Dean Schillinger
- Division of General Internal Medicine, Center for Vulnerable Populations, San Francisco General Hospital, University of California San Francisco School of Medicine, San Francisco, CA
| | - Ann Bullock
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD
| | - Clydette Powell
- Division of Neurology, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Naomi K. Fukagawa
- Beltsville Human Nutrition Research Center, U.S. Department of Agriculture Agricultural Research Service, Beltsville, MD
| | | | - Jana Towne
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD
| | - Jasmine D. Gonzalvo
- Center for Health Equity and Innovation, Purdue University/Eskenazi Health, Indianapolis, IN
| | - Aaron M. Lopata
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
| | | | - William H. Herman
- Division of Metabolism, Endocrinology, and Diabetes, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI
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Abstract
PURPOSE OF REVIEW In 2020, obesity prevalence among US children reached 19.7%, impacting about 14.7 million children and adolescents. Food insecurity among children is also a public health concern but has largely decreased or remained stable over the past decade, reaching 6.2% of US households with children in 2021. Given food insecurity and obesity's interconnected nature and their negative consequences on children's health, it is of interest to assess the Supplemental Nutrition Assistance Program's (SNAP's) impact on childhood food security, dietary quality, disease risk, and health outcomes. RECENT FINDINGS Evidence suggests that SNAP participants, including children, struggle to meet key dietary guidelines and perform poorly on key health indicators when compared with income-eligible and higher income nonparticipants. Children participating in SNAP were more likely to have elevated disease risk and consume more sugar-sweetened beverages (SSBs), more high-fat dairy, and more processed meats than income-eligible nonparticipants. However, research suggests that federal food assistance programs with more stringent nutrition standards - the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and the National School Lunch Program (NSLP) and School Breakfast Program (SBP) - improve dietary quality, increase birth weight and gestation periods, and reduce childhood obesity, infant mortality and healthcare costs. SUMMARY After reviewing the evidence on SNAP's impacts on food insecurity, dietary quality, and health as well as research on the health impacts of other more successful federal food assistance programs, we provide three policy recommendations to strengthen SNAP's effectiveness as a health intervention for children and families.
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29
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Kowalski C, Dustin D, Johnson LK, Belury MA, Conrad Z. Fat Intake Modifies the Association between Restricted Carbohydrate Diets and Prevalent Cardiometabolic Diseases among Adults in the United States: National Health and Nutrition Examination Survey, 1999-2018. Curr Dev Nutr 2023; 7:100019. [PMID: 37181133 PMCID: PMC10100922 DOI: 10.1016/j.cdnut.2022.100019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Background Cardiometabolic diseases (CMDs), which include heart disease, stroke, and diabetes, account for over one-third of the mortality burden in the United States annually. Nearly one-half of all deaths from CMD are attributable to suboptimal diet quality, and many Americans are turning to special diets for general health improvement. Among the most popular of these diets restrict daily carbohydrate intake to <45% of energy, yet their association with CMD is not well understood. Objectives This study evaluated the association between restricted carbohydrate diets and prevalent CMD, stratified by fat intake. Methods Dietary and CMD data were retrieved from 19,078 participants aged ≥20 y in the National Health and Nutrition Examination Survey, 1999-2018. The National Cancer Institute methodology was used to assess usual dietary intake. Results Compared to participants that met recommendations for all macronutrients, those that consumed restricted carbohydrate diets were 1.15 (95% CI: 1.14, 1.16) times as likely to have CMD; and those that met recommendations for carbohydrates, but not all macronutrients, were 1.02 (95% CI: 1.02, 1.03) times as likely to have CMD. Higher intakes of saturated and polyunsaturated fat were associated with greater prevalence of CMD in restricted and recommended carbohydrate intake groups. Higher intake of monounsaturated fat was associated with lower prevalence of CMD among participants that met carbohydrate, but not all macronutrient, recommendations. Conclusions To our knowledge, this is the first nationally representative study to evaluate the relationship between carbohydrate restriction and CMD, stratifying by fat intake. Greater efforts are needed to understand longitudinal relationships between carbohydrate restriction and CMD.
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Affiliation(s)
- Corina Kowalski
- College of Arts & Sciences, William & Mary, Williamsburg, VA, USA
| | - Dakota Dustin
- Department of Human Sciences, Ohio State University, Columbus, OH, USA
| | | | - Martha A. Belury
- Department of Human Sciences, Ohio State University, Columbus, OH, USA
| | - Zach Conrad
- Department of Kinesiology, William & Mary, Williamsburg, VA, USA
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30
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Rowe S, Tukun AB, Johnson LK, Love DC, Belury MA, Conrad Z. Consumption of Key Food Groups by Individuals Consuming Popular Diet Patterns: Mixed Effects of Replacing Foods High in Added Sugar, Sodium, Saturated Fat, and Refined Grains. Nutrients 2022; 14:nu14245226. [PMID: 36558385 PMCID: PMC9783956 DOI: 10.3390/nu14245226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/22/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
Adults in the United States are increasingly following 'popular' diet patterns that restrict food groups, macronutrients, or eating time. However, the intake of food groups associated with these diet patterns has not been well characterized. The objectives of this study were to (1) characterize the mean intake of food groups among consumers of popular diet patterns in the US, and (2) model the effect of targeted food substitutions on the intake of food groups. Data were acquired from the National Health and Nutrition Examination Survey, 2005-2018 (n = 34,411). A diet model was developed to assess the effects of replacing one serving each of foods highest in added sugar, sodium, saturated fat, and refined grains with healthy alternatives on the intake of key food groups for each diet pattern. Modeled replacement resulted in increased intake of fruit and whole grains and decreased intake of dairy for most diet patterns, while the effects on the intake of vegetables, protein foods, and oils were variable across diet patterns. The complexity of the natural eating environment, in which many people consume mixed dishes that include both healthy and less healthy ingredients, produces a challenge for health professionals when providing dietary counseling. Nevertheless, this substitution approach may help improve adherence to dietary guidelines, especially if used as a steppingstone for further dietary improvement.
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Affiliation(s)
- Sarah Rowe
- College of Arts & Sciences, William & Mary, Williamsburg, VA 23185, USA
| | - Avonti Basak Tukun
- Program of Human Nutrition, The Ohio State University, Columbus, OH 43221, USA
| | | | - David C. Love
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore, MD 21202, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Martha A. Belury
- Program of Human Nutrition, The Ohio State University, Columbus, OH 43221, USA
| | - Zach Conrad
- Department of Kinesiology, William & Mary, Williamsburg, VA 23185, USA
- Global Research Institute, William & Mary, Williamsburg, VA 23185, USA
- Correspondence: ; Tel.: +1-757-221-2037
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31
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Wang X, Ma H, Gupta S, Heianza Y, Fonseca V, Qi L. The Joint Secular Trends of Sleep Quality and Diabetes Among US Adults, 2005-2018. J Clin Endocrinol Metab 2022; 107:3152-3161. [PMID: 35776011 PMCID: PMC9681613 DOI: 10.1210/clinem/dgac401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Sleep quality has been related to the risk of diabetes; however, little is known about the prevalence of diabetes in the United States according to the levels of sleep quality. OBJECTIVE To examine the joint secular trends of the overall sleep quality and diabetes among US adults from 2005-2006 to 2017-2018. METHODS Seven cycles of cross-sectional National Health and Nutrition Examination Survey (NHANES) data between 2005-2006 and 2017-2018 were included. Nonpregnant adults aged 20 years or older were eligible for the study. A healthy sleep score was calculated to represent overall sleep quality. The prevalence of diabetes was estimated and mean levels of fasting plasma glucose (FPG), glycated hemoglobin, and insulin resistance were calculated. RESULTS Both the estimated age-standardized prevalence of diabetes and changing trend in prevalence of diabetes varied by the overall sleep quality groups. The highest prevalence of diabetes was consistently observed in the low sleep quality group in each cycle, in which a significantly increasing trend was also noted across cycles (P for trend = .004). In contrast, the lowest prevalence of diabetes was consistently observed in the high sleep quality group in each cycle, in which no increasing trend over time was observed (P for trend = .346). CONCLUSIONS Overall sleep quality decreased significantly between 2005-2006 and 2017-2018 among US adults. The estimated prevalence of diabetes and related measures only increased in participants with low or medium overall sleep quality but remained stable in participants with high sleep quality.
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Affiliation(s)
- Xuan Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Hao Ma
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Shaveta Gupta
- Section of Endocrinology and Metabolism, Tulane University School of Medicine, New Orleans, LA 70112, USA
- Southeast Louisiana Veterans Health Care System, New Orleans, LA 70112, USA
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Vivian Fonseca
- Section of Endocrinology and Metabolism, Tulane University School of Medicine, New Orleans, LA 70112, USA
- Southeast Louisiana Veterans Health Care System, New Orleans, LA 70112, USA
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston 02115, MA, USA
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Tao MH, Liu JL, Nguyen USDT. Trends in Diet Quality by Race/Ethnicity among Adults in the United States for 2011-2018. Nutrients 2022; 14:nu14194178. [PMID: 36235830 PMCID: PMC9570938 DOI: 10.3390/nu14194178] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
This study aimed to investigate time trends in diet quality and the consumption of major food groups and nutrients by race/ethnicity among adults in the United States. Dietary data from 19,192 adults aged ≥ 20 years from four National Health and Nutrition Survey (NHANES) cycles (2011-2018) were included. The Healthy Eating Index (HEI) 2015 scores (range: 0-100; higher scores indicate better diet quality) and dietary consumption of food groups and nutrients were estimated for each cycle. Linear regression was used to test trends. For the overall population, the estimated overall HEI-2015 scores significantly decreased (p for trend = 0.011). However, decreases were observed in the estimated consumption of added sugars and total carbohydrates, while the estimated consumption of soy products and polyunsaturated fatty acids was significantly increased. A significant decrease in overall HEI-2015 score was observed in the non-Hispanic white group, but not in other racial/ethnic groups. Decreases in added sugar intake were found in the non-Hispanic black and Hispanic groups; sodium intake significantly decreased in the non-Hispanic Asian group. From 2011 to 2018, there was a decrease in estimated overall diet quality in US adults; however, there were improvements in certain nutrients and dietary components. Nevertheless, disparities in diet quality exist among racial/ethnic groups.
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Affiliation(s)
- Meng-Hua Tao
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI 48202, USA
- Correspondence: ; Tel.: +1-313-876-8471; Fax: +1-313-874-6730
| | - Jia-Liang Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA 19122, USA
| | - Uyen-Sa D. T. Nguyen
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
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Blankenship J, Blancato RB. Nutrition Security at the Intersection of Health Equity and Quality Care. J Acad Nutr Diet 2022; 122:S12-S19. [PMID: 36122954 PMCID: PMC9477722 DOI: 10.1016/j.jand.2022.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 12/02/2022]
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Ambikapathi R, Schneider KR, Davis B, Herrero M, Winters P, Fanzo JC. Global food systems transitions have enabled affordable diets but had less favourable outcomes for nutrition, environmental health, inclusion and equity. NATURE FOOD 2022; 3:764-779. [PMID: 37118149 DOI: 10.1038/s43016-022-00588-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 08/11/2022] [Indexed: 11/09/2022]
Abstract
AbstractOver the past 50 years, food systems worldwide have shifted from predominantly rural to industrialized and consolidated systems, with impacts on diets, nutrition and health, livelihoods, and environmental sustainability. We explore the potential for sustainable and equitable food system transformation (ideal state of change) by comparing countries at different stages of food system transition (changes) using food system typologies. Historically, incomes have risen faster than food prices as countries have industrialized, enabling a simultaneous increase in the supply and affordability of many nutritious foods. These shifts are illustrated across five food system typologies, from rural and traditional to industrial and consolidated. Evolving rural economies, urbanization and changes in food value chains have accompanied these transitions, leading to changes in land distribution, a smaller share of agri-food system workers in the economy and changes in diets. We show that the affordability of a recommended diet has improved over time, but food systems of all types are falling short of delivering optimal nutrition and health outcomes, environmental sustainability, and inclusion and equity for all. Six ‘outlier’ case studies (Tajikistan, Egypt, Albania, Ecuador, Bolivia and the United States of America) illustrate broad trends, trade-offs and deviations. With the integrated view afforded by typologies, we consider how sustainable transitions can be achieved going forward.
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Murphy R, Marshall K, Zagorin S, Devarshi PP, Hazels Mitmesser S. Socioeconomic Inequalities Impact the Ability of Pregnant Women and Women of Childbearing Age to Consume Nutrients Needed for Neurodevelopment: An Analysis of NHANES 2007-2018. Nutrients 2022; 14:nu14183823. [PMID: 36145198 PMCID: PMC9500720 DOI: 10.3390/nu14183823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 11/28/2022] Open
Abstract
Adequate consumption of nutrients that support infant neurodevelopment is critical among pregnant women and women of childbearing age. Understanding the potential effects of socioeconomic inequalities on nutrient gaps in these life stages is thus important for informing strategies to mitigate negative health consequences. Usual intake (foods and dietary supplements) of neurodevelopment-related nutrients was determined from 24 h recalls among women of childbearing age and pregnant women (20−44 years) using data from 2007−2018 NHANES. Usual intake was compared across household food security, poverty-to-income ratio (PIR), and household participation in federal food and nutrition assistance programs. Intake of EPA + DHA was universally low with >95% of all women (pregnant and non-pregnant) below the DGA recommendation from foods alone. Women in households that participated in the Supplemental Nutrition Assistance Program had a significantly lower intake of multiple nutrients relative to those who did not participate. For example, 50% had intakes below the estimated average requirement (EAR) for vitamin A (versus 32%), 42% were below the EAR for calcium (versus 33%) and 65% were below the EAR for magnesium (versus 42%). Similar gradients were observed by PIR and household food security, and among pregnant women whereby gaps were more evident in those experiencing socioeconomic inequalities. The use of dietary supplements attenuated shortfalls for most nutrients. These findings highlight a critical need to support the nutritional requirements for women of childbearing age and pregnant women.
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Affiliation(s)
- Rachel Murphy
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 1L3, Canada
- Correspondence: ; Tel.: +1-604-822-1397
| | - Keri Marshall
- Science & Technology, Pharmavite LLC, West Hills, CA 91304, USA
| | - Sandra Zagorin
- Science & Technology, Pharmavite LLC, West Hills, CA 91304, USA
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Miller V, Webb P, Cudhea F, Shi P, Zhang J, Reedy J, Erndt-Marino J, Coates J, Mozaffarian D. Global dietary quality in 185 countries from 1990 to 2018 show wide differences by nation, age, education, and urbanicity. NATURE FOOD 2022; 3:694-702. [PMID: 37118151 DOI: 10.1038/s43016-022-00594-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/12/2022] [Indexed: 04/30/2023]
Abstract
Evidence on what people eat globally is limited in scope and rigour, especially as it relates to children and adolescents. This impairs target setting and investment in evidence-based actions to support healthy sustainable diets. Here we quantified global, regional and national dietary patterns among children and adults, by age group, sex, education and urbanicity, across 185 countries between 1990 and 2018, on the basis of data from the Global Dietary Database project. Our primary measure was the Alternative Healthy Eating Index, a validated score of diet quality; Dietary Approaches to Stop Hypertension and Mediterranean Diet Score patterns were secondarily assessed. Dietary quality is generally modest worldwide. In 2018, the mean global Alternative Healthy Eating Index score was 40.3, ranging from 0 (least healthy) to 100 (most healthy), with regional means ranging from 30.3 in Latin America and the Caribbean to 45.7 in South Asia. Scores among children versus adults were generally similar across regions, except in Central/Eastern Europe and Central Asia, high-income countries, and the Middle East and Northern Africa, where children had lower diet quality. Globally, diet quality scores were higher among women versus men, and more versus less educated individuals. Diet quality increased modestly between 1990 and 2018 globally and in all world regions except in South Asia and Sub-Saharan Africa, where it did not improve.
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Affiliation(s)
- Victoria Miller
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
- Population Health Research Institute, Hamilton, Ontario, Canada.
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Frederick Cudhea
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Peilin Shi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Jianyi Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - Julia Reedy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Josh Erndt-Marino
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Jennifer Coates
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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McCormick N, Lu N, Yokose C, Joshi AD, Sheehy S, Rosenberg L, Warner ET, Dalbeth N, Merriman TR, Saag KG, Zhang Y, Choi HK. Racial and Sex Disparities in Gout Prevalence Among US Adults. JAMA Netw Open 2022; 5:e2226804. [PMID: 35969396 PMCID: PMC9379746 DOI: 10.1001/jamanetworkopen.2022.26804] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Emerging data suggest gout and hyperuricemia may now be more frequent among Black adults in the US than White adults, especially Black women. However, national-level, sex-specific general population data on racial differences in gout prevalence and potential socioclinical risk factors are lacking. OBJECTIVE To identify sex-specific factors driving disparities between Black and White adults in contemporary gout prevalence in the US general population. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis used nationally representative, decadal survey data from successive cycles of the National Health and Nutrition Examination Survey from 2007 to 2016. Data were analyzed from November 1, 2019, through May 31, 2021. Participants included US adults self-reporting Black or White race. EXPOSURES Self-reported race, excess body mass index, chronic kidney disease (CKD; defined as estimated glomerular filtration rate <60 mL/min/1.73 m2, according to latest equations without race coefficient), poverty, poor-quality diet, low educational level, alcohol consumption, and diuretic use. MAIN OUTCOMES AND MEASURES Race- and sex-specific prevalence of physician- or clinician-diagnosed gout and hyperuricemia and their differences before and after adjusting for potential socioclinical risk factors. RESULTS A total of 18 693 participants were included in the analysis, consisting of 3304 Black women (mean [SD] age, 44.8 [0.4] years), 6195 White women (mean [SD] age, 49.8 [0.3] years), 3085 Black men (mean [SD] age, 43.6 [0.5] years]), and 6109 White men (mean [SD] age, 48.2 [0.3] years). Age-standardized prevalence of gout was 3.5% (95% CI, 2.7%-4.3%) in Black women and 2.0% (95% CI, 1.5%-2.5%) in White women (age-adjusted odds ratio [OR], 1.81 [95% CI, 1.29-2.53]); prevalence was 7.0% (95% CI, 6.2%-7.9%) in Black men and 5.4% (95% CI, 4.7%-6.2%) in White men (age-adjusted OR, 1.26 [95% CI, 1.02-1.55]). These associations attenuated after adjusting for poverty, diet, body mass index, and CKD among women and for diet and CKD among men but became null after adjusting for all risk factors (ORs, 1.05 [95% CI, 0.67-1.65] among women and 1.05 [95% CI, 0.80-1.35] among men). Hyperuricemia end point findings were similar. CONCLUSIONS AND RELEVANCE In this nationally representative race- and sex-specific cross-sectional study of US adults, gout was more prevalent in adults self-reporting Black race during a recent 10-year period compared with their White counterparts. These racial differences may be explained by sex-specific differences in diet and social determinants of health and clinical factors. Culturally informed efforts focusing on these factors could reduce current gout-related disparities.
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Affiliation(s)
- Natalie McCormick
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Arthritis Research Canada, Vancouver, British Columbia
| | - Na Lu
- Arthritis Research Canada, Vancouver, British Columbia
| | - Chio Yokose
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Amit D. Joshi
- Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston
| | - Shanshan Sheehy
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Erica T. Warner
- Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Boston, Massachusetts
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Tony R. Merriman
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Kenneth G. Saag
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - Yuqing Zhang
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Hyon K. Choi
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Arthritis Research Canada, Vancouver, British Columbia
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The California Nutrition Incentive Program: Participants’ Perceptions and Associations with Produce Purchases, Consumption, and Food Security. Nutrients 2022; 14:nu14132699. [PMID: 35807882 PMCID: PMC9268255 DOI: 10.3390/nu14132699] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/24/2022] [Indexed: 02/05/2023] Open
Abstract
We examined the associations of a Supplemental Nutrition Assistance Program (SNAP) point-of-purchase financial incentive program at farmers’ markets with produce purchase, consumption, and food security outcomes. We conducted cross-sectional, interviewer-administered intercept surveys with 325 adult SNAP participants at six incentive programs, five comparison farmers’ markets, and nine comparison supermarkets in California in the summer of 2018. The program provided dollar-for-dollar point-of-purchase incentives with $10 or $20 maximum at participating farmers’ markets. We measured produce consumption by an NCI screener; food security by the USDA 6-item screener; and program satisfaction with open-ended questions asked of a subsample. The quantitative analysis involved multilevel linear and logistic regression, adjusted for covariates. Qualitative data were coded and analyzed thematically. Shoppers at farmers’ markets offering $20 incentives had significantly higher odds of purchasing most of their produce at farmers’ markets than shoppers at $10 incentive (3.1, CI: 1.1, 8.7) or comparison markets (8.1, CI 2.2, 29.7). Incentives were not associated with quantitatively measured produce consumption. Each additional incentive dollar was associated with reduced odds of food insecurity (0.987, CI 0.976, 0.999). Participants appreciated the program; supermarket shoppers lacked awareness. Point-of-purchase incentives are appreciated and underutilized. Further understanding of optimal program design for produce consumption and food security impact is needed.
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Understanding Impacts of SNAP Fruit and Vegetable Incentive Program at Farmers' Markets: Findings from a 13 State RCT. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127443. [PMID: 35742692 PMCID: PMC9223796 DOI: 10.3390/ijerph19127443] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 01/22/2023]
Abstract
Disparities in healthy food access and consumption are a major public health concern. This study reports the findings from a two-year randomized control trial conducted at 77 farmers' markets (FMs) in 13 states and the District of Columbia that sought to understand the impact of fruit and vegetable (FV) incentive vouchers, randomly issued at varied incentive levels to Supplemental Nutrition Assistance Program (SNAP) recipients, for use at FMs. Measures included FV and overall household food purchasing; FV consumption; food insecurity; health status; market expenditure; and demographics. A repeated-measures mixed-effects analysis and the Complier Average Causal Effect (CACE) were used to examine outcomes. Despite 82% reporting food insecurity in the prior year, the findings showed that financial incentives at FMs had statistically significant, positive effects on FV consumption; market expenditures increased with added incentives. SNAP recipients receiving an incentive of USD 0.40 for every USD 1.00 in SNAP spent an average of USD 19.03 per transaction, while those receiving USD 2 for every USD 1 (2:1) spent an average of USD 36.28 per transaction. The data showed that the incentive program at the highest level (2:1) maximally increased SNAP FM expenditure and FV consumption, increasing the latter by 0.31 daily cups among those who used their incentive (CACE model).
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De Silva DA, Thoma ME, Anderson EA, Kim J. Infant Sex-Specific Associations between Prenatal Food Insecurity and Low Birthweight: A Multistate Analysis. J Nutr 2022; 152:1538-1548. [PMID: 35265994 DOI: 10.1093/jn/nxac062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/07/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Low birthweight is associated with increased risk of neonatal mortality and adverse outcomes among survivors. As maternal sociodemographic factors do not explain all of the risk in low birthweight, exploring exposures occurring during critical periods, such as maternal food insecurity, should be considered from a life course perspective. OBJECTIVES To explore the association between prenatal food insecurity and low birthweight, as well as whether or not there may be a sex-specific response using a multistate survey. METHODS Pregnancy Risk Assessment Monitoring System (PRAMS) data of live births from 11 states during 2009-2017 were used, restricting to women with a singleton birth. Food insecurity was determined by a single question in PRAMS, and low birthweight was defined as a birth <2500 g. Multivariable logistic regression was used, stratified by infant sex and adjusted for maternal sociodemographic and prepregnancy health characteristics. RESULTS There were n = 50,915 women from 2009 to 2017, with 9.1% experiencing food insecurity. Unadjusted results revealed that food-insecure mothers had an increased odds ratio of delivering a low-birthweight baby (OR: 1.38; 95% CI: 1.25, 1.53). Adjustment for covariates appeared to explain the association among male infants, whereas magnitudes remained greater among female infants (adjusted OR: 1.13; 95% CI: 0.94, 1.35). CONCLUSIONS Findings suggest a sex-specific response to prenatal food insecurity, particularly among female offspring. Future studies are warranted with more precise measures of food insecurity and to understand the difference by infant sex.
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Affiliation(s)
- Dane A De Silva
- Division of Population Health Data, Office of Family Health Services, Virginia Department of Health, Richmond, VA, USA
| | - Marie E Thoma
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
| | - Elaine A Anderson
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
| | - Jinhee Kim
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
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Hecht AA, Dunn CG, Kinsey EW, Read MA, Levi R, Richardson AS, Hager ER, Seligman HK. Estimates of the Nutritional Impact of Non-Participation in the National School Lunch Program during COVID-19 School Closures. Nutrients 2022; 14:1387. [PMID: 35406001 PMCID: PMC9003403 DOI: 10.3390/nu14071387] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 12/04/2022] Open
Abstract
The COVID-19 pandemic resulted in widespread school closures, reducing access to school meals for millions of students previously participating in the US Department of Agriculture (USDA) National School Lunch Program (NSLP). School-prepared meals are, on average, more nutritious than home-prepared meals. In the absence of recent data measuring changes in children's diets during the pandemic, this article aims to provide conservative, back-of-the-envelope estimates of the nutritional impacts of the pandemic for school-aged children in the United States. We used administrative data from the USDA on the number of NSLP lunches served in 2019 and 2020 and nationally representative data from the USDA School Nutrition and Meal Cost Study on the quality of school-prepared and home-prepared lunches. We estimate changes in lunchtime calories and nutrients consumed by NSLP participants from March to November 2020, compared to the same months in 2019. We estimate that an NSLP participant receiving no school meals would increase their caloric consumption by 640 calories per week and reduce their consumption of nutrients such as calcium and vitamin D. Because 27 to 78 million fewer lunches were served per week in March-November 2020 compared to the previous year, nationally, students may have consumed 3 to 10 billion additional calories per week. As students return to school, it is vital to increase school meal participation and update nutrition policies to address potentially widening nutrition disparities.
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Affiliation(s)
- Amelie A. Hecht
- Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Caroline Glagola Dunn
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Eliza W. Kinsey
- Department of Family Medicine & Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | | | - Ronli Levi
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, CA 94143, USA; (R.L.); (H.K.S.)
| | | | - Erin R. Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Hilary K. Seligman
- Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, CA 94143, USA; (R.L.); (H.K.S.)
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Leung CW, Fulay AP, Parnarouskis L, Martinez-Steele E, Gearhardt AN, Wolfson JA. Food insecurity and ultra-processed food consumption: the modifying role of participation in the Supplemental Nutrition Assistance Program (SNAP). Am J Clin Nutr 2022; 116:197-205. [PMID: 35199832 PMCID: PMC9257471 DOI: 10.1093/ajcn/nqac049] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/14/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Ultra-processed foods contribute to risks of obesity and cardiometabolic disease, and higher intakes have been observed in low-income populations in the United States. Consumption of ultra-processed foods may be particularly higher among individuals experiencing food insecurity and participating in the Supplemental Nutrition Assistance Program (SNAP). OBJECTIVES Using data from the 2007-2016 NHANES, we examined the associations between food insecurity, SNAP participation, and ultra-processed food consumption. METHODS The study population comprised 9190 adults, aged 20-65 y, with incomes ≤300% of the federal poverty level (FPL). Food insecurity was assessed using the Household Food Security Survey Module and SNAP participation over the past 12 mo was self-reported. Dietary intake was measured from two 24-h dietary recalls. Ultra-processed food consumption (percentage of total energy intake) was defined using the NOVA food classification system. Linear regression models were used to examine the associations between food insecurity, SNAP participation, and ultra-processed food consumption, adjusting for sociodemographic and health characteristics. RESULTS More severe food insecurity was associated with higher intakes of ultra-processed foods (P-trend = 0.003). The adjusted means of ultra-processed food intake ranged from 52.6% for adults with high food security to 55.7% for adults with very low food security. SNAP participation was also associated with higher intakes of ultra-processed foods (adjusted mean: 54.7%), compared with income-eligible participants (adjusted mean: 53.0%). Furthermore, the association between food insecurity and ultra-processed foods was modified by SNAP participation (P-interaction = 0.02). Among income-eligible nonparticipants and income-ineligible nonparticipants, more severe food insecurity was associated with higher consumption of ultra-processed foods. Among SNAP participants, the association between food insecurity and consumption of ultra-processed foods was nonsignificant. CONCLUSION In a nationally representative sample of adults, food insecurity and SNAP participation were both associated with higher levels of ultra-processed food consumption.
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Affiliation(s)
| | - Aarohee P Fulay
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Lindsey Parnarouskis
- Department of Psychology, College of Literature, Science, and Arts, University of Michigan, Ann Arbor, MI, USA
| | - Euridice Martinez-Steele
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| | - Ashley N Gearhardt
- Department of Psychology, College of Literature, Science, and Arts, University of Michigan, Ann Arbor, MI, USA
| | - Julia A Wolfson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Short E, Kohler LN, Taren D, Gonzalez R, Roe DJ, Hingle M. Diet Quality Following Food Pantry Visit Differs by Ethnicity. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022; 17:69-84. [PMID: 35280518 PMCID: PMC8916714 DOI: 10.1080/19320248.2020.1860849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Food insecurity is associated with poor diet quality and increased diet-related disease risk. Food pantry clients (n=194) completed one 24-hour dietary recall and the Healthy Eating Index-2015 was used to evaluate diet quality. Differences in diet quality relative to participants' last food pantry visit and self-reported ethnicity were evaluated using two-way ANOVA. Food pantry visits within 1-4 days compared to ≥5 days were associated with higher diet quality in non-Hispanics (p=0.01) but diet quality remained the same in Hispanics. Interventions to improve diet quality in food pantry users must consider potential ethnic differences when program planning.
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Affiliation(s)
- Eliza Short
- University of Arizona Department of Nutritional Sciences, 1177 E 4th St, Tucson, AZ, 85721,University of Arizona Collaboratory for Metabolic Disease Prevention and Treatment, 3950 S Country Club Rd Suite 330, Tucson, AZ, 85714
| | - Lindsay N. Kohler
- University of Arizona Mel & Enid Zuckerman College of Public Health, 1295 N. Martin Ave, Tucson, AZ, 85724
| | - Douglas Taren
- University of Arizona Mel & Enid Zuckerman College of Public Health, 1295 N. Martin Ave, Tucson, AZ, 85724
| | - Rhonda Gonzalez
- Community Food Bank of Southern Arizona, 3003 S Country Club Rd, Tucson, AZ 85713
| | - Denise J Roe
- University of Arizona Mel & Enid Zuckerman College of Public Health, 1295 N. Martin Ave, Tucson, AZ, 85724
| | - Melanie Hingle
- University of Arizona Department of Nutritional Sciences, 1177 E 4th St, Tucson, AZ, 85721,University of Arizona Collaboratory for Metabolic Disease Prevention and Treatment, 3950 S Country Club Rd Suite 330, Tucson, AZ, 85714
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Sharma SV, McWhorter JW, Chow J, Danho MP, Weston SR, Chavez F, Moore LS, Almohamad M, Gonzalez J, Liew E, LaRue DM, Galvan E, Hoelscher DM, Tseng KC. Impact of a Virtual Culinary Medicine Curriculum on Biometric Outcomes, Dietary Habits, and Related Psychosocial Factors among Patients with Diabetes Participating in a Food Prescription Program. Nutrients 2021; 13:nu13124492. [PMID: 34960044 PMCID: PMC8707163 DOI: 10.3390/nu13124492] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
Culinary medicine is an evidence-based approach that blends the art of cooking with the science of medicine to inculcate a healthy dietary pattern. Food prescription programs are gaining popularity in the Unites States, as a means to improve access to healthy foods among patient populations. The purpose of this paper is to describe the implementation and preliminary impact of A Prescription for Healthy Living (APHL) culinary medicine curriculum on biometric and diet-related behavioral and psychosocial outcomes among patients with diabetes participating in a clinic-led food prescription (food Rx) program. We used a quasi-experimental design to assess APHL program impact on patient biometric outcome data obtained from electronic health records, including glycosylated hemoglobin (HbA1c), body mass index (BMI), and blood pressure (n = 33 patients in the APHL group, n = 75 patients in the food Rx-only group). Pre-post surveys were administered among those in the APHL group to monitor program impact on psychosocial and behavioral outcomes. Results of the outcome analysis showed significant pre-to-post reduction in HbA1c levels among participants within the APHL group (estimated mean difference = -0.96% (-1.82, -0.10), p = 0.028). Between-group changes showed a greater decrease in HbA1c among those participating in APHL as compared to food Rx-only, albeit these differences were not statistically significant. Participation in APHL demonstrated significant increases in the consumption of fruits and vegetables, fewer participants reported that cooking healthy food is difficult, increased frequency of cooking from scratch, and increased self-efficacy in meal planning and cooking (p < 0.01). In conclusion, the results of our pilot study suggest the potential positive impact of a virtually-implemented culinary medicine approach in improving health outcomes among low-income patients with type 2 diabetes, albeit studies with a larger sample size and a rigorous study design are needed.
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Affiliation(s)
- Shreela V. Sharma
- Department of Epidemiology, Human Genetics & Environmental Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health, 1200 Pressler, Houston, TX 77030, USA; (J.C.); (M.P.D.); (F.C.); (M.A.)
- Correspondence: ; Tel.: +1-713-500-9344
| | - John W. McWhorter
- Department of Health Promotion Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health, 1200 Pressler, Houston, TX 77030, USA; (J.W.M.); (S.R.W.); (L.S.M.)
| | - Joanne Chow
- Department of Epidemiology, Human Genetics & Environmental Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health, 1200 Pressler, Houston, TX 77030, USA; (J.C.); (M.P.D.); (F.C.); (M.A.)
| | - Melisa P. Danho
- Department of Epidemiology, Human Genetics & Environmental Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health, 1200 Pressler, Houston, TX 77030, USA; (J.C.); (M.P.D.); (F.C.); (M.A.)
| | - Shannon R. Weston
- Department of Health Promotion Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health, 1200 Pressler, Houston, TX 77030, USA; (J.W.M.); (S.R.W.); (L.S.M.)
| | - Fatima Chavez
- Department of Epidemiology, Human Genetics & Environmental Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health, 1200 Pressler, Houston, TX 77030, USA; (J.C.); (M.P.D.); (F.C.); (M.A.)
| | - Laura S. Moore
- Department of Health Promotion Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health, 1200 Pressler, Houston, TX 77030, USA; (J.W.M.); (S.R.W.); (L.S.M.)
| | - Maha Almohamad
- Department of Epidemiology, Human Genetics & Environmental Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas School of Public Health, 1200 Pressler, Houston, TX 77030, USA; (J.C.); (M.P.D.); (F.C.); (M.A.)
| | - Jennifer Gonzalez
- Population Health, Harris Health System, 4800 Fournace Place, Bellaire, TX 77401, USA; (J.G.); (D.M.L.); (E.G.); (K.C.T.)
| | - Esther Liew
- Food For Change Health Partnerships, Houston Food Bank, 535 Portwall Street, Houston, TX 77029, USA;
| | - Denise M. LaRue
- Population Health, Harris Health System, 4800 Fournace Place, Bellaire, TX 77401, USA; (J.G.); (D.M.L.); (E.G.); (K.C.T.)
| | - Esperanza Galvan
- Population Health, Harris Health System, 4800 Fournace Place, Bellaire, TX 77401, USA; (J.G.); (D.M.L.); (E.G.); (K.C.T.)
| | - Deanna M. Hoelscher
- Department of Health Promotion Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, Austin Regional Campus, University of Texas School of Public Health, 1616 Guadalupe, Austin, TX 78701, USA;
| | - Karen C. Tseng
- Population Health, Harris Health System, 4800 Fournace Place, Bellaire, TX 77401, USA; (J.G.); (D.M.L.); (E.G.); (K.C.T.)
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Khatana SAM, Illenberger N, Werner RM, Groeneveld PW, Mitra N. Changes in Supplemental Nutrition Assistance Program Policies and Diabetes Prevalence: Analysis of Behavioral Risk Factor Surveillance System Data From 2004 to 2014. Diabetes Care 2021; 44:2699-2707. [PMID: 34607835 PMCID: PMC8669531 DOI: 10.2337/dc21-1203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/04/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Food insecurity is associated with diabetes. The Supplemental Nutrition Assistance Program (SNAP) is the largest U.S. government food assistance program. Whether such programs impact diabetes trends is unclear. The objective of this study was to evaluate the association between changes in state-level policies affecting SNAP participation and county-level diabetes prevalence. RESEARCH DESIGN AND METHODS We evaluated the association between change in county-level diabetes prevalence and changes in the U.S. Department of Agriculture SNAP policy index-a measure of adoption of state-level policies associated with increased SNAP participation (higher value indicating adoption of more policies associated with increased SNAP participation; range 1-10)-from 2004 to 2014 using g-computation, a robust causal inference methodology. The study included all U.S. counties with diabetes prevalence data available from the Centers for Disease Control and Prevention's U.S. Diabetes Surveillance System. RESULTS The study included 3,135 of 3,143 U.S. counties. Mean diabetes prevalence increased from 7.3% (SD 1.3) in 2004 to 9.1% (SD 1.8) in 2014. The mean SNAP policy index increased from 6.4 (SD 0.9) to 8.2 (SD 0.6) in 2014. After accounting for changes in demographic-, economic-, and health care-related variables and the baseline SNAP policy index, a 1-point absolute increase in the SNAP policy index between 2004 and 2014 was associated with a 0.050 (95% CI 0.042-0.057) percentage point lower diabetes prevalence per year. CONCLUSIONS State policies aimed at increasing SNAP participation were independently associated with a lower rise in diabetes prevalence between 2004 and 2014.
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Affiliation(s)
- Sameed Ahmed M Khatana
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA .,Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Nicholas Illenberger
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rachel M Werner
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Center for Health Equity Research and Promotion, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | - Peter W Groeneveld
- Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Center for Health Equity Research and Promotion, Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | - Nandita Mitra
- The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Wang L, Du M, Cudhea F, Griecci C, Michaud DS, Mozaffarian D, Zhang FF. Disparities in Health and Economic Burdens of Cancer Attributable to Suboptimal Diet in the United States, 2015‒2018. Am J Public Health 2021; 111:2008-2018. [PMID: 34648383 PMCID: PMC8630501 DOI: 10.2105/ajph.2021.306475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To quantify disparities in health and economic burdens of cancer attributable to suboptimal diet among US adults. Methods. Using a probabilistic cohort state-transition model, we estimated the number of new cancer cases and cancer deaths, and economic costs of 15 diet-related cancers attributable to suboptimal intake of 7 dietary factors (a low intake of fruits, vegetables, dairy, and whole grains and a high intake of red and processed meats and sugar-sweetened beverages) among a closed cohort of US adults starting in 2017. Results. Suboptimal diet was estimated to contribute to 3.04 (95% uncertainty interval [UI] = 2.88, 3.20) million new cancer cases, 1.74 (95% UI = 1.65, 1.84) million cancer deaths, and $254 (95% UI = $242, $267) billion economic costs among US adults aged 20 years or older over a lifetime. Diet-attributable cancer burdens were higher among younger adults, men, non-Hispanic Blacks, and individuals with lower education and income attainments than other population subgroups. The largest disparities were for cancers attributable to high consumption of sugar-sweetened beverages and low consumption of whole grains. Conclusions. Suboptimal diet contributes to substantial disparities in health and economic burdens of cancer among young adults, men, racial/ethnic minorities, and socioeconomically disadvantaged groups. (Am J Public Health. 2021;111(11):2008-2018. https://doi.org/10.2105/AJPH.2021.306475).
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Affiliation(s)
- Lu Wang
- Lu Wang, Mengxi Du, Frederick Cudhea, Christina Griecci, Dariush Mozaffarian, and Fang Fang Zhang are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Dominique S. Michaud is with the Department of Public Health and Community Medicine, School of Medicine, Tufts University
| | - Mengxi Du
- Lu Wang, Mengxi Du, Frederick Cudhea, Christina Griecci, Dariush Mozaffarian, and Fang Fang Zhang are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Dominique S. Michaud is with the Department of Public Health and Community Medicine, School of Medicine, Tufts University
| | - Frederick Cudhea
- Lu Wang, Mengxi Du, Frederick Cudhea, Christina Griecci, Dariush Mozaffarian, and Fang Fang Zhang are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Dominique S. Michaud is with the Department of Public Health and Community Medicine, School of Medicine, Tufts University
| | - Christina Griecci
- Lu Wang, Mengxi Du, Frederick Cudhea, Christina Griecci, Dariush Mozaffarian, and Fang Fang Zhang are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Dominique S. Michaud is with the Department of Public Health and Community Medicine, School of Medicine, Tufts University
| | - Dominique S Michaud
- Lu Wang, Mengxi Du, Frederick Cudhea, Christina Griecci, Dariush Mozaffarian, and Fang Fang Zhang are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Dominique S. Michaud is with the Department of Public Health and Community Medicine, School of Medicine, Tufts University
| | - Dariush Mozaffarian
- Lu Wang, Mengxi Du, Frederick Cudhea, Christina Griecci, Dariush Mozaffarian, and Fang Fang Zhang are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Dominique S. Michaud is with the Department of Public Health and Community Medicine, School of Medicine, Tufts University
| | - Fang Fang Zhang
- Lu Wang, Mengxi Du, Frederick Cudhea, Christina Griecci, Dariush Mozaffarian, and Fang Fang Zhang are with the Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA. Dominique S. Michaud is with the Department of Public Health and Community Medicine, School of Medicine, Tufts University
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Anderson E, Wei R, Liu B, Plummer R, Kelahan H, Tamez M, Marrero A, Bhupathiraju S, Mattei J. Improving Healthy Food Choices in Low-Income Settings in the United States Using Behavioral Economic-Based Adaptations to Choice Architecture. Front Nutr 2021; 8:734991. [PMID: 34692747 PMCID: PMC8526839 DOI: 10.3389/fnut.2021.734991] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/08/2021] [Indexed: 12/27/2022] Open
Abstract
Low diet quality is a significant public health problem in the United States, especially among low-income populations. The food environment influences dietary choices. When applied to eating behavior, behavioral economics (BE) recognizes that decision biases instigated by a food environment saturated with unhealthy foods may lead people to purchase such foods, even when they possess the necessary information and skills to make healthy dietary choices. Choice architecture, a BE concept that involves modifying the appeal or availability of choices to “nudge” people toward a certain choice, retains freedom of choice but makes unhealthy options less convenient or visible. Choice architecture has been demonstrated to influence food choices in various settings, including supermarkets, convenience stores, and food pantries. These modifications are low-cost and feasible to implement, making them a viable strategy to help “nudge” patrons toward healthier choices in food establishments serving low-income populations, including food pantries and retailers accepting the Supplemental Nutrition Assistance Program. This narrative review searched, appraised, and underscored the strengths and limitations of extant research studies that used choice architecture adaptations to influence food choices among low-income populations in the United States. Findings from studies in food pantry settings suggest the potential of BE strategies to improve the healthfulness of food choices and dietary intake in low-income populations. In food retail settings, research suggests that BE strategies increase sales of healthy foods, like fruits and vegetables. We identify new areas of research needed to determine if BE-based modifications in low-income settings have sustained impacts on diet quality.
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Affiliation(s)
- Emma Anderson
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Ruobin Wei
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Binkai Liu
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Rachel Plummer
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Heather Kelahan
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Martha Tamez
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Abrania Marrero
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Shilpa Bhupathiraju
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Josiemer Mattei
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States
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48
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Chen TA, Reitzel LR, Obasi EM, Dave JM. Did School Meal Programs and SNAP Participation Improve Diet Quality of US Children from Low-Income Households: Evidence from NHANES 2013-2014? Nutrients 2021; 13:nu13103574. [PMID: 34684575 PMCID: PMC8540084 DOI: 10.3390/nu13103574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/03/2021] [Accepted: 10/09/2021] [Indexed: 11/16/2022] Open
Abstract
Nutrition assistance programs such as school meals and the Supplemental Nutrition Assistance Program (SNAP) are designed to provide a safety net for the dietary intake of children from low-income families. However, compared with eligible non-participants, the relationship of diet quality with school meals only and school meals + SNAP is not well understood. The objectives of the study include: (1) To explore whether and to what extent nutrition assistance program participation (school meals only and school meals + SNAP) is related to diet quality; and (2) to examine the differences of diet quality between participating in school meals only, school meals + SNAP, or non-participation among American children. Children aged 5 to 18 years old from income eligible households who participated in the 2013-2014 National Health and Nutrition Examination Survey (NHANES) were included in this cross-sectional study (n = 1425). Diet quality was measured using the Healthy Eating Index (HEI)-2015 and its 13 subcomponents. A Rao-Scott Chi-square test, propensity scores approach, and Analysis of Covariance were performed. Covariates included age, sex, race/ethnicity, weight status, and family monthly poverty index. SAS survey procedures were used to incorporate the appropriate sample design weights. Participation in school meals + SNAP was not associated with higher diet quality compared to eligible non-participants or school meals-only participants. Participation in school meals + SNAP improved the intake of total dairy, but not added sugars or total vegetables compared to school meals only. Overall, school meal + SNAP participation did not significantly improve the overall diet quality of children in low-income households relative to comparable non-participants.
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Affiliation(s)
- Tzuan A. Chen
- Department of Psychological, Health and Learning Sciences, College of Education, The University of Houston, 3657 Cullen Blvd. Stephen Power Farish Hall, Houston, TX 77204, USA; (L.R.R.); (E.M.O.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
- Correspondence: ; Tel.: +1-713-743-6345
| | - Lorraine R. Reitzel
- Department of Psychological, Health and Learning Sciences, College of Education, The University of Houston, 3657 Cullen Blvd. Stephen Power Farish Hall, Houston, TX 77204, USA; (L.R.R.); (E.M.O.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Ezemenari M. Obasi
- Department of Psychological, Health and Learning Sciences, College of Education, The University of Houston, 3657 Cullen Blvd. Stephen Power Farish Hall, Houston, TX 77204, USA; (L.R.R.); (E.M.O.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Jayna M. Dave
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates St., Houston, TX 77030, USA;
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49
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Associations Among Select State Policies and the Nutritional Quality of Household Packaged Food Purchases in the United States from 2008 Through 2017. J Acad Nutr Diet 2021; 122:731-744.e32. [PMID: 34626825 DOI: 10.1016/j.jand.2021.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/12/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Policy interventions are important public health tools because they can reach large numbers of people. State context has been associated with health outcomes, yet few studies have examined the extent to which state-level policies are associated with dietary quality. OBJECTIVES The objective of this study was to evaluate whether state policies are associated with the nutritional quality of household packaged food purchases. DESIGN This observational study used data from Nielsen Homescan, an open-cohort household panel where participants track purchases, and a combination of state-level food and social safety net policy variables from 2008 through 2017. PARTICIPANTS AND SETTING This study included 615,634 household-year observations in the United States from 2008 through 2017. Household-year observations were excluded in the case that a household did not make a minimum number of purchases and in the case that they had incorrect geographic information. The final analytic sample was 611,719 household-years. MAIN OUTCOME MEASURES Study outcomes included a set of nutrition-related measures of public health interest, including nutrients of concern (eg, sugar, saturated fat, and sodium) and calories from specific food groups (eg, fruits, nonstarchy vegetables, processed meats, mixed dishes, sugar-sweetened beverages, and desserts and snacks). STATISTICAL ANALYSIS This study used multilevel generalized linear models with state fixed effects on three samples: all households, only households with low income, and only households with low educational attainment. RESULTS Few significant associations were found between healthy food retail policies and the nutritional quality of purchases, and mixed associations were found between social safety net policies and lower or higher quality packaged food purchases. CONCLUSIONS Little evidence was found that state policy context in 2008 through 2017 was associated with the quality of packaged food purchases. However, variation in state policies is increasing over time, warranting future research into the relationship between these policies, the quality of packaged food purchases, and the rest of the diet.
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50
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Olstad DL, Nejatinamini S, Victorino C, Kirkpatrick SI, Minaker LM, McLaren L. Socioeconomic inequities in diet quality among a nationally representative sample of adults living in Canada: an analysis of trends between 2004 and 2015. Am J Clin Nutr 2021; 114:1814-1829. [PMID: 34477821 PMCID: PMC8574630 DOI: 10.1093/ajcn/nqab249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/02/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Socioeconomic inequities in diet quality are stable or widening in the United States; however, these trends have not been well characterized in other nations. Moreover, purpose-developed indices of inequities that can provide a more comprehensive and precise perspective of trends in absolute and relative dietary gaps and gradients using multiple indicators of socioeconomic position (SEP) have not yet been used, and can inform strategies to narrow dietary inequities. OBJECTIVES We quantified nationally representative trends in absolute and relative gaps and gradients in diet quality between 2004 and 2015 according to 3 indicators of SEP among adults in Canada. METHODS Adults (≥18 y old) who participated in the nationally representative, cross-sectional Canadian Community Health Survey-Nutrition in 2004 (n = 20,880) or 2015 (n = 13,970) were included. SEP was classified using household income (quintiles), education (5 categories), and neighborhood deprivation (quintiles). Dietary intake data from 24-h recalls were used to derive Healthy Eating Index-2015 (HEI-2015) scores. Dietary inequities were quantified using absolute and relative gaps (between the most and least disadvantaged) and absolute [Slope Index of Inequality (SII)] and relative gradients (Relative Index of Inequality). Overall and sex-stratified multivariable linear regression and generalized linear models examined trends in HEI-2015 scores between 2004 and 2015. RESULTS Mean HEI-2015 scores improved from 55.3 to 59.0 (maximum: 100); however, these trends were not consistently equitable. Whereas inequities in HEI-2015 scores were stable in the total population and in females, the absolute gap [from 1.60 (95% CI: 0.09, 3.10) to 4.27 (95% CI: 2.20, 6.34)] and gradient [from SII = 2.09 (95% CI: 0.45, 3.73) to SII = 4.84 (95% CI: 2.49, 7.20)] in HEI-2015 scores for household income, and the absolute gradient for education [from SII = 8.06 (95% CI: 6.41, 9.71) to SII = 10.52 (95% CI: 8.73, 12.31)], increased in males. CONCLUSIONS Absolute and relative gaps and gradients in overall diet quality remained stable or widened between 2004 and 2015 among adults in Canada.
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Affiliation(s)
| | - Sara Nejatinamini
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Charlie Victorino
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sharon I Kirkpatrick
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Leia M Minaker
- School of Planning, University of Waterloo, Waterloo, Ontario, Canada
| | - Lindsay McLaren
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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