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Dugani SB, Lahr BD, Xie H, Mielke MM, Bailey KR, Vella A. County Rurality and Incidence and Prevalence of Diagnosed Diabetes in the United States. Mayo Clin Proc 2024:S0025-6196(23)00572-4. [PMID: 38506780 DOI: 10.1016/j.mayocp.2023.11.022] [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: 03/09/2023] [Revised: 11/02/2023] [Accepted: 11/15/2023] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To examine differences in the incidence and prevalence of diagnosed diabetes by county rurality. PATIENTS AND METHODS This observational, cross-sectional study used US Centers for Disease Control and Prevention data from 2004 through 2019 for county estimates of incidence and prevalence of diagnosed diabetes. County rurality was based on 6 levels (large central metro counties [most urban] to noncore counties [most rural]). Weighted least squares regression was used to relate rurality with diabetes incidence rates (IRs; per 1000 adults) and prevalence (percentage) in adults aged 20 years or older after adjusting for county-level sociodemographic factors (eg, food environment, health care professionals, inactivity, obesity). RESULTS Overall, in 3148 counties and county equivalents, the crude IR and prevalence of diabetes were highest in noncore counties. In age and sex ratio-adjusted models, the IR of diabetes increased monotonically with increasing rurality (P<.001), whereas prevalence had a weak, nonmonotonic but statistically significant increase (P=.002). Further adjustment for sociodemographic factors including food environment, health care professionals, inactivity, and obesity attenuated differences in incidence across rurality levels, and reversed the pattern for prevalence (prevalence ratios [vs large central metro] ranged from 0.98 [95% CI, 0.97 to 0.99] for large fringe metro to 0.94 [95% CI, 0.93 to 0.96] for noncore). In region-stratified analyses adjusted for sociodemographic factors including inactivity and obesity, increasing rurality was inversely associated with incidence in the Midwest and West only and inversely associated with prevalence in all regions. CONCLUSION The crude incidence and prevalence of diagnosed diabetes increased with increasing county rurality. After accounting for sociodemographic factors including food environment, health care professionals, inactivity, and obesity, county rurality showed no association with incidence and an inverse association with prevalence. Therefore, interventions targeting modifiable sociodemographic factors may reduce diabetes disparities by region and rurality.
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Affiliation(s)
- Sagar B Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN; Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
| | - Brian D Lahr
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Hui Xie
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Michelle M Mielke
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN; Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Kent R Bailey
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Adrian Vella
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
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Hampson HE, Costello E, Walker DI, Wang H, Baumert BO, Valvi D, Rock S, Jones DP, Goran MI, Gilliland FD, Conti DV, Alderete TL, Chen Z, Chatzi L, Goodrich JA. Associations of dietary intake and longitudinal measures of per- and polyfluoroalkyl substances (PFAS) in predominantly Hispanic young Adults: A multicohort study. ENVIRONMENT INTERNATIONAL 2024; 185:108454. [PMID: 38316574 PMCID: PMC11089812 DOI: 10.1016/j.envint.2024.108454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/14/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) are pollutants linked to adverse health effects. Diet is an important source of PFAS exposure, yet it is unknown how diet impacts longitudinal PFAS levels. OBJECTIVE To determine if dietary intake and food sources were associated with changes in blood PFAS concentrations among Hispanic young adults at risk of metabolic diseases. METHODS Predominantly Hispanic young adults from the Children's Health Study who underwent two visits (CHS; n = 123) and young adults from NHANES 2013-2018 who underwent one visit (n = 604) were included. Dietary data at baseline was collected using two 24-hour dietary recalls to measure individual foods and where foods were prepared/consumed (home/restaurant/fast-food). PFAS were measured in blood at both visits in CHS and cross-sectionally in NHANES. In CHS, multiple linear regression assessed associations of baseline diet with longitudinal PFAS; in NHANES, linear regression was used. RESULTS In CHS, all PFAS except PFDA decreased across visits (all p < 0.05). In CHS, A 1-serving higher tea intake was associated with 24.8 %, 16.17 %, and 12.6 % higher PFHxS, PFHpS, and PFNA at follow-up, respectively (all p < 0.05). A 1-serving higher pork intake was associated with 13.4 % higher PFOA at follow-up (p < 0.05). Associations were similar in NHANES, including unsweetened tea, hot dogs, and processed meats. For food sources, in CHS each 200-gram increase in home-prepared food was associated with 0.90 % and 1.6 % lower PFOS at baseline and follow-up, respectively, and in NHANES was associated with 0.9 % lower PFDA (all p < 0.05). CONCLUSION Results suggest that beverage consumption habits and food preparation are associated with differences in PFAS levels in young adults. This highlights the importance of diet in determining PFAS exposure and the necessity of public monitoring of foods and beverages for PFAS contamination.
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Affiliation(s)
- Hailey E Hampson
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, the United States of America
| | - Elizabeth Costello
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, the United States of America
| | - Douglas I Walker
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, the United States of America
| | - Hongxu Wang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, the United States of America
| | - Brittney O Baumert
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, the United States of America
| | - Damaskini Valvi
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, the United States of America
| | - Sarah Rock
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, the United States of America
| | - Dean P Jones
- Clinical Biomarkers Laboratory, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA, the United States of America
| | - Michael I Goran
- Department of Pediatrics, Keck School of Medicine, USC and The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA 90027, the United States of America
| | - Frank D Gilliland
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, the United States of America
| | - David V Conti
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, the United States of America
| | - Tanya L Alderete
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, the United States of America
| | - Zhanghua Chen
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, the United States of America
| | - Leda Chatzi
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, the United States of America
| | - Jesse A Goodrich
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, the United States of America.
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Meneses-Urrea LA, Vaquero-Abellán M, Villegas Arenas D, Benachi Sandoval N, Hernández-Carrillo M, Molina-Recio G. Factors Associated with Dietary Patterns in Colombia. Nutrients 2023; 15:2079. [PMID: 37432184 DOI: 10.3390/nu15092079] [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: 03/20/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 07/12/2023] Open
Abstract
The selection of food depends on various factors such as cultural, social, economic and biological. This paper determines the factors associated with dietary patterns in Colombia. It is an observational, descriptive exploratory study collecting secondary data from the National Survey of Nutritional Status of Colombia (ENSIN, 2015) of 16,216 people between 15 and 64 years of age. The variables were the following: area, age range, sex, educational level, high blood pressure arterial hypertension (HTA), diabetes (DM), cancer, wealth quartile and dietary pattern. For the data analysis, logistic regression models were generated for each pattern and OR was used as a measure of association. Of those studied, 74.6% live in urban areas, all were aged between 15 and 49 years and 45.4% were in the first wealth quartile (Q1). There was a greater probability of traditional and conservative dietary patterns in people with diabetes and hypertension. Consumption of the conservative pattern was associated with being a woman, while consumption of the traditional pattern was associated with people in the first and second wealth level. Consumption of grill/beverage was more likely in men. Socio-demographic factors and chronic non-communicable diseases are associated with dietary patterns. This makes it relevant for health professionals to take into account these characteristics for nutritional interventions.
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Affiliation(s)
- Luz Adriana Meneses-Urrea
- Research Group "Health Care (Recognized by Colciencias)", University Santiago of Cali, Cali 760001, Colombia
- Department of Nursing, University Santiago of Cali, Cali 760001, Colombia
| | - Manuel Vaquero-Abellán
- IMIBIC GC12 Clinical and Epidemiological Research in Primary Care (GICEAP), 14014 Córdoba, Spain
- Department of Nursing, Pharmacology and Physiotherapy, University of Córdoba, 14014 Córdoba, Spain
| | - Dolly Villegas Arenas
- Research Group "Health Care (Recognized by Colciencias)", University Santiago of Cali, Cali 760001, Colombia
- Department of Nursing, University Santiago of Cali, Cali 760001, Colombia
| | - Narly Benachi Sandoval
- Research Group "Health Care (Recognized by Colciencias)", University Santiago of Cali, Cali 760001, Colombia
- CAP Casanova, Consorci D'Atenció Primària de Salut Barcelona Esquerra, 08036 Barcelona, Spain
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, University of Bacelona, 08036 Barcelona, Spain
| | | | - Guillermo Molina-Recio
- Department of Nursing, Pharmacology and Physiotherapy, University of Córdoba, 14014 Córdoba, Spain
- Lifestyles, Innovation and Health (GA-16), Maimonides Biomedical Research Institute of Córdoba (IMIBIC), 14014 Córdoba, Spain
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Zhao R, Zhao L, Gao X, Yang F, Yang Y, Fang H, Ju L, Xu X, Guo Q, Li S, Cheng X, Cai S, Yu D, Ding G. Geographic Variations in Dietary Patterns and Their Associations with Overweight/Obesity and Hypertension in China: Findings from China Nutrition and Health Surveillance (2015-2017). Nutrients 2022; 14:nu14193949. [PMID: 36235601 PMCID: PMC9572670 DOI: 10.3390/nu14193949] [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: 08/24/2022] [Revised: 09/14/2022] [Accepted: 09/21/2022] [Indexed: 02/07/2023] Open
Abstract
Regional dietetic cultures were indicated in China, but how dietary patterns geographically varied across China is unknown. Few studies systematically investigated the association of dietary patterns with overweight/obesity and hypertension and the potential mechanism with a national sample. This study included 34,040 adults aged 45 years and older from China Nutrition and Health Surveillance (2015−2017), who had complete outcome data, reliable intakes of calorie and cooking oils, unchanged diet habits, and without diagnosed cancer or cardiovascular disease. Outcomes were overweight/obesity and hypertension. By using the Gaussian finite mixture models, four dietary patterns were identified—common rice-based dietary pattern (CRB), prudent diversified dietary pattern (PD), northern wheat-based dietary pattern (NWB), and southern rice-based dietary pattern (SRB). Geographic variations in dietary patterns were depicted by age−sex standardized proportions of each pattern across 31 provinces in China. We assessed the association of these dietary patterns with outcomes and calculated the proportion mediated (PM) by overweight/obesity in the association of the dietary patterns with hypertension. Evident geographic disparities in dietary patterns across 31 provinces were observed. With CRB as reference group and covariates adjusted, the NWB had higher odds of being overweight/obese (odds ratio (OR) = 1.44, 95% confidence interval (CI): 1.36−1.52, p < 0.001) and hypertension (OR = 1.07, 95%CI: 1.01−1.14, p < 0.001, PM = 43.2%), while the SRB and the PD had lower odds of being overweight/obese (ORs = 0.84 and 0.92, 95%CIs: 0.79−0.89 and 0.85−0.99, p < 0.001 for both) and hypertension (ORs = 0.93 and 0.87, 95%CIs: 0.87−0.98 and 0.80−0.94, p = 0.038 for SRB and p < 0.001 for PD, PMs = 27.8% and 9.9%). The highest risk of overweight/obesity in the NWB presented in relatively higher carbohydrate intake (about 60% of energy) and relatively low fat intake (about 20% of energy). The different trends in the association of protein intake with overweight/obesity among dietary patterns were related to differences in animal food sources. In conclusion, the geographic distribution disparities of dietary patterns illustrate the existence of external environment factors and underscore the need for geographic-targeted dietary actions. Optimization of the overall dietary pattern is the key to the management of overweight/obesity and hypertension in China, with the emphasis on reducing low-quality carbohydrate intake, particularly for people with the typical northern diet, and selection of animal foods, particularly for people with the typical southern diet.
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Affiliation(s)
- Rongping Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Liyun Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, State College, PA 16802, USA
| | - Fan Yang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
| | - Yuxiang Yang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Hongyun Fang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Lahong Ju
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xiaoli Xu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Qiya Guo
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Shujuan Li
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xue Cheng
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Shuya Cai
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Dongmei Yu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- Correspondence: (D.Y.); (G.D.)
| | - Gangqiang Ding
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
- Correspondence: (D.Y.); (G.D.)
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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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