Socioeconomic factors associated with diet quality and meeting dietary guidelines in disadvantaged neighborhoods in the Southeast United States

Anemia and food insecurity: the nutritional struggles of pregnant women in Lebanon amid unprecedented crises

BACKGROUND

Pregnant women require specific dietary intake to optimize fetal development and support mother's health. The ongoing crises in Lebanon: the economic crisis, the COVID-19 pandemic, and the Beirut port explosion, limited the population's overall ability to consume a well-balanced diet, preventing adequate consumption of fresh, whole food and possibly disrupting people's eating habits, notably for pregnant women. Given the vulnerability of pregnant women to malnutrition and diseases during those times, research on the nutrition status and intake of pregnant women is urgently needed to inform targeted policies and programs. This study explores nutritional status (malnutrition and anemia), food insecurity, and diet quality, and associated factors in Lebanese adult pregnant women residing in Lebanon.

METHODS

A cross sectional study was conducted on a representative sample of 500 adult Lebanese pregnant women who were in different pregnancy trimesters, between March and October 2023. Collected data included sociodemographic and medical characteristics, anthropometrics, serum hemoglobin, food security status, and diet quality using validated tools.

RESULTS

A total of 38.6% of the participants had anemia, with more than half (53.8%) reporting not taking iron supplements. Food insecurity prevalence was 14.6% based on the "Food Insecurity Experience Scale" and 22.6% based on the "Arab Family Food Security Scale". Although most women in the sample (79.2%) had a high minimum dietary diversity (MDD-W) score and an acceptable household dietary diversity, however; around 38% and 81.6% of them had low adherence to the Mediterranean Diet (MD) and the USDA dietary guidelines, respectively. Being in the second (aOR: 1.77) or third (aOR:1.88) pregnancy trimesters increased the likelihoods of anemia; while being employed (aOR: 0.46) and having a higher household income (aOR: 0.639) decreased the likelihood of maternal anemia. Living in a crowded household (aOR: 0.072) decreased the odds of high MDD-W, while being employed (aOR: 2.88), being food secure (aOR: 1.76) and living in the North and Akkar (aOR: 2.44) or South and Nabatieh (aOR: 2.06) increased the odds of high MDD-W. Being food secure (aOR: 1.87) increased the likelihood of fair to very good MD adherence, while having a higher household income (aOR: 0.57) decreased adherence to MD. A higher household income (aOR: 0.57) decreased the adherence to USDA dietary guidelines.

CONCLUSION

Anemia, compounded by low levels of iron supplementation and low adherence to healthy diets, warrant immediate public action given the detrimental effects they have on pregnancy outcomes. National comprehensive nutrition policies and interventions are thus needed to enhance adherence to healthy diets and the overall health of pregnant women. This also requires improving the food security situation of Lebanese pregnant women, as our findings showed that food security increases the odds of dietary diversity and adherence to the MD.

Relationship between metabolic syndrome and dietary diversity in the Rafsanjan cohort study

The rapid increase in metabolic syndrome (MetS) as a major public health problem may be attributed to changes in population behavior patterns in modern society, including nutritional habits and physical activity. Therefore, this study investigated the association between dietary diversity score (DDS) and adult metabolic syndrome. In this cross-sectional study, 9715 participants aged 35-70 years from the Rafsanjan Cohort Study (RCS) were included. Demographic, medical, and habitual histories were collected. DDS was calculated using a food frequency questionnaire (FFQ). All analyses were performed using Stata 14, with p-values < 0.05. Based on the DDS, subjects were divided into four groups (quartiles). The multivariate-adjusted model showed that the risk of MetS increased by 18% in the third quartile and by 25% in the fourth quartile (OR: 1.18; 98% CI: 1.02-1.36 and OR: 1.25; 98% CI: 1.06-1.48, respectively). Additionally, an increased risk of high serum triglyceride levels was observed in the third quartile (OR: 1.19; 98% CI: 1.05-1.35). The results suggest that there is a relationship between DDS and metabolic syndrome, although this relationship changed after adjusting for confounders.

"Sometimes We Can't Afford the Healthy Stuff": Perceptions of Cardiovascular Disease Risk and Healthy Food Accessibility Among Black Women Living in Public Housing

African American women living in public housing carry a heavy burden of cardiovascular disease. Eating a heart-healthy diet is crucial to achieving optimal heart health, yet this health disparity population encounters major barriers to healthy eating. This study explored their perceptions of healthy eating and cardiovascular disease. Participants were recruited from public housing in a mid-sized city. Six 2-h focus groups with 32 women were conducted. Focus groups were analyzed using deductive coding. The major focus group findings focused on a limited access to affordable healthy foods. Participants also discussed the use of cost control measures to maximize household food budgets to access healthy foods and the ability to eat healthily. Our findings indicate that food insecurity persists for the populations most at-risk for cardiovascular disease. Plant-based diets may offer a culturally sensitive, innovative, and sustainable approach to reducing heart health risks, alleviating food insecurity, and promoting optimal health outcomes.

Dietary intakes differ between LGBTQ + and non-LGBTQ + college students

Objective: To compare dietary intakes between LGBTQ + and non-LGBTQ + college students. Participants: Participants were LGBTQ+ (n = 92) and non-LGBTQ+ (n = 491) college students. Methods: The 26-item Dietary Screener Questionnaire assessed intakes of added sugars, fiber, whole grains, fruits and vegetables, dairy, and calcium. Percentage of participants meeting Dietary Guidelines for Americans were also computed. Multivariate ANCOVA assessed differences in dietary intake. Chi-square analyses assessed differences in proportions of LGBTQ + and non-LGBTQ + students meeting recommendations. Results: LGBTQ + students reported lower intakes of fiber, whole grains, fruit, and fruits and vegetables both including and excluding French fries (all p < 0.05). Fewer LGBTQ + students met recommendations for fruit (5.7%) compared to their non-LGBTQ + counterparts (14.2%; p = .03). Conclusions: LGBTQ + students report poorer indices of diet quality compared to non-LGBTQ + students. Health promotion programming efforts to improve these outcomes may need to be tailored differently for students who identify as LGBTQ+.

Education, urbanicity of residence, and cardiometabolic biomarkers among middle-aged and older populations in the US, Mexico, China, and India

Background

The relationship between education and cardiometabolic biomarkers is contextually dependent on both inter-country and intra-country factors. This study aimed to examine educational differences in cardiometabolic biomarkers among middle-aged and older adults in the US, Mexico, China, and India, and whether this relationship is modified by urbanicity of residence.

Methods

Data were from contemporary cross-sectional waves of the US Health and Retirement Study (HRS; 2016/17, n = 19,608), the Mexican Health and Aging Study (MHAS; 2015, n = 12,356), the China Health and Retirement Longitudinal Study (CHARLS; 2015/16, n = 13,268), and the Longitudinal Aging Study in India (LASI; 2017/19, n = 47,838). To account for substantial variations in educational distribution across the four countries, we measured education attainment in two ways: by categorizing education levels into binary classifications ('lower education: lower secondary education or below' vs. 'higher education: upper secondary education or above') to assess absolute education attainment, and by using within-country percentile ranks to capture relative education attainment. We assessed educational differences in four cardiometabolic biomarkers: body mass index (BMI), systolic blood pressure (SBP), glycated haemoglobin (HbA1c), and total cholesterol. We tested whether urbanicity of residence modified the relationship between education and these cardiometabolic biomarkers.

Results

The proportion of individuals with higher education was 82.6% in the US, 15.6% in Mexico, 10.6% in China, and 16.8% in India. In the US, higher education was associated with lower SBP (-2.74 mmHg, 95% CI: -3.62, -1.86) and HbA1c (-0.14%, 95% CI: -0.20, -0.08), but higher total cholesterol (3.33 mg/dL, 95% CI: 1.41, 5.25). In Mexico, higher education was associated with lower BMI only (-0.51 kg/m2, 95% CI: -0.76, -0.26). In China, higher education was not associated with any biomarker. In India, higher education was associated with higher BMI (1.61 kg/m2, 95% CI: 1.49, 1.73), SBP (1.67 mmHg, 95% CI: 1.16, 2.18), and HbA1c (0.35%, 95% CI: 0.19, 0.51). The association between education and cardiometabolic biomarkers was modified by urbanicity in China and India but not in the US or Mexico. In both China and India, relationships between education and cardiometabolic biomarkers were stronger among rural residents compared to those among urban residents. Results based on relative education attainment showed similar patterns in terms of the direction of the effect estimates, despite some discrepancies in statistical significance.

Interpretation

There is a complex relationship between education and cardiometabolic biomarkers across countries and by urbanicity of residence. This complexity underscores the importance of accounting for contextual factors when devising strategies to enhance cardiometabolic health in various settings.

Impact of socioeconomic determinants on outcomes of eight select conditions for which self-care is a modality for prevention and treatment: a scoping review

We conducted a scoping review of peer-reviewed literature published between January 1, 1990 and October 31, 2021, to identify socioeconomic determinants that contribute to higher burden and adverse outcomes in diseases for which self-care is an important modality of treatment and prevention. We identified these diseases using over-the-counter medicines sales data sourced from IQVIA. We searched Ovid Medline, PubMed, and EMBASE databases for articles published in English using inclusion/exclusion criteria. We analyzed articles covering 42 diseases that qualified as cardiovascular disorders (219 studies including ischemic heart disease, myocardial infarction, stroke, and related risk factors such as hypertension, dyslipidemia and atrial fibrillation), nutritional disorders (66 studies including malnutrition which encompasses undernutrition and micronutrient deficiencies, and anemia), digestive disorders (40 studies including gastroesophageal reflux disorder, inflammatory bowel disease, and dyspepsia), allergy disorders (40 studies including asthma and allergic rhinitis), pain disorders (14 studies including lower back pain, knee pain, generalized musculoskeletal pain and headaches), dermatological disorders (23 studies including atopic dermatitis [eczema], occupational dermatosis, and facial dermatitis), respiratory disorders (11 studies including chronic cough, pneumonia, chronic bronchitis, wheezing, and influenza), and gynecological disorders (29 studies including bacterial vaginosis and trichomoniasis vaginosis). We found that lifestyle factors were the commonly reported risk factors, and residential segregation, education, and income were the commonly reported socioeconomic determinants. A closer analysis of income within each disorder revealed that it is more often associated with health conditions that are self-limiting. Although we did not find any discernible relationship between the commonly reported socioeconomic factors and the prevalence of self-medication for the health conditions considered, income plays an important role in the burden and outcomes of conditions that require more self-care compared to those that require less self-care.

Factors associated with diet quality of adolescents in Saudi Arabia

Introduction

Research exploring factors that may influence the diet quality of adolescents in the Middle East are very limited. We aimed to investigate factors associated with diet quality and the weight status of adolescents in Saudi Arabia.

Methods

A cross-sectional study that included 638 healthy adolescents aged between 11 and 18 years who were randomly recruited from 16 private and public middle- and high-schools located in two Saudi cities (Jeddah and Madinah). All participants were given an envelope for parents to collect socioeconomic data. Diet quality and anthropometric data of adolescents were evaluated at school.

Results

Median diet quality score was higher among males compared to female adolescents (10.00 (8.00-11.00) vs. 9.00 (8.00-10.0), respectively, p = 0.018). Median diet quality score was significantly higher among adolescents residing in Jeddah compared to adolescents residing in Madinah (10.00 (9.00-11.0) vs. 9.00 (8.00-10.0), respectively, p = 0.002). Stepwise linear regression analysis indicated that city of residence (B = -0.53, SE = 0.16 [95% CI: -0.83 to -0.22]), and child's sex (B = -0.34, SE = 0.15 [95% CI: -0.64 to -0.05]) were associated with diet quality scores of adolescents in Saudi Arabia.

Discussion

Future longitudinal research should be directed to further investigate other possible factors influencing the diet quality of adolescents and individuals from other age groups in Saudi Arabia.

Associations of neighborhood sociodemographic environment with mortality and circulating metabolites among low-income black and white adults living in the southeastern United States

BACKGROUND

Residing in a disadvantaged neighborhood has been linked to increased mortality. However, the impact of residential segregation and social vulnerability on cause-specific mortality is understudied. Additionally, the circulating metabolic correlates of neighborhood sociodemographic environment remain unexplored. Therefore, we examined multiple neighborhood sociodemographic metrics, i.e., neighborhood deprivation index (NDI), residential segregation index (RSI), and social vulnerability index (SVI), with all-cause and cardiovascular disease (CVD) and cancer-specific mortality and circulating metabolites in the Southern Community Cohort Study (SCCS).

METHODS

The SCCS is a prospective cohort of primarily low-income adults aged 40-79, enrolled from the southeastern United States during 2002-2009. This analysis included self-reported Black/African American or non-Hispanic White participants and excluded those who died or were lost to follow-up ≤ 1 year. Untargeted metabolite profiling was performed using baseline plasma samples in a subset of SCCS participants.

RESULTS

Among 79,631 participants, 23,356 deaths (7214 from CVD and 5394 from cancer) were documented over a median 15-year follow-up. Higher NDI, RSI, and SVI were associated with increased all-cause, CVD, and cancer mortality, independent of standard clinical and sociodemographic risk factors and consistent between racial groups (standardized HRs among all participants were 1.07 to 1.20 in age/sex/race-adjusted model and 1.04 to 1.08 after comprehensive adjustment; all P < 0.05/3 except for cancer mortality after comprehensive adjustment). The standard risk factors explained < 40% of the variations in NDI/RSI/SVI and mediated < 70% of their associations with mortality. Among 1110 circulating metabolites measured in 1688 participants, 134 and 27 metabolites were associated with NDI and RSI (all FDR < 0.05) and mediated 61.7% and 21.2% of the NDI/RSI-mortality association, respectively. Adding those metabolites to standard risk factors increased the mediation proportion from 38.4 to 87.9% and 25.8 to 42.6% for the NDI/RSI-mortality association, respectively.

CONCLUSIONS

Among low-income Black/African American adults and non-Hispanic White adults living in the southeastern United States, a disadvantaged neighborhood sociodemographic environment was associated with increased all-cause and CVD and cancer-specific mortality beyond standard risk factors. Circulating metabolites may unveil biological pathways underlying the health effect of neighborhood sociodemographic environment. More public health efforts should be devoted to reducing neighborhood environment-related health disparities, especially for low-income individuals.

Impact of food insecurity and food environment on the diet quality of older African Americans during the COVID-19 pandemic

Introduction

A high quality diet is vital in promoting wellbeing and ensuring good health, particularly for those living with chronic conditions. Older African Americans, already burdened with a higher prevalence of chronic conditions, also face a higher risk for suboptimal diets. The COVID-19 pandemic had lasting effects on access to healthy food for all Americans, but some demographic groups were disproportionately affected. Older African Americans, who already experienced reduced access to healthy food pre-pandemic, were particularly afflicted, but the full extent of the pandemic's impact on their food insecurity and food environment remains unclear.

Methods

To address this gap, we conducted a study among 102 older African Americans in South Los Angeles between October 2021 and July 2022 during the COVID-19 pandemic. Participants completed surveys on dietary intake, food insecurity, and neighborhood food environment. We measured dietary quality using the healthy eating index (HEI)-2015. The analysis included descriptive, bivariate chi-square, t-tests, analysis of variance, and multiple linear and logistic regression.

Results

While overall dietary quality was suboptimal, most participants met the guidelines for fruit and vegetable consumption. Food insecurity was associated with lower overall diet quality and lower total fruit and whole fruit intake. However, there was no association between food environment and diet quality.

Discussion

In light of our findings, further intervention is critical to improving diet quality, especially among older African Americans living with chronic conditions in the post-pandemic era.

The palm or the plate? An assessment of dietary guideline promotion, awareness, and preferences among Saudis: cross-sectional survey

BACKGROUND

Dietary Guidelines for Saudis are offered and promoted in two forms: the Healthy Food Palm and the Saudi Healthy Plate. However, public awareness, recognition, and engagement with these guidelines is not well studied. Understanding the factors behind dietary guideline promotion, awareness, recognition, and use may lead to greater optimization of and engagement with the guidelines. This study aims to assess recognition of and public engagement with the My Palm and My Plate dietary guidelines as well as dietary guideline awareness, perceptions, and preferences among Saudis.

METHODS

To compare awareness, knowledge, and usability between the Healthy Food Palm and the Saudi Healthy Plate dietary guidelines, a cross-sectional survey-based study was conducted among Saudi adult males and females above 18 (n = 674) between October 2021 and January 2022. Participants were split into groups based on age and gender. T-test and χ2 tests were used to determine differences between groups for continuous and categorical variables, respectively.

RESULTS

Most participants were unaware of the Healthy Food Palm and the Saudi Healthy Plate guidelines, with only 11.1% and 30.3% able to recognize guideline-associated visual illustrations, respectively. However, nearly half of the participants correctly identified the number of food groups in the Healthy Food Palm and Saudi Healthy Plate. As well, more than half of the sample preferred the Saudi Healthy Plate, while one-quarter of the sample preferred neither guideline. In terms of future public health promotion, participants identified that "convenience and availability" (29.6%) and "my own health" (28.6%) were the most influential dietary choice factors with "social media campaigns" (2.4%) and the involvement of "an influencer" (3.1%) being the least influential dietary choice factors.

CONCLUSIONS

Implementation of and public awareness of dietary guidelines is less than optimal, and opportunities exist for greater information dissemination and public engagement. Measurement and ongoing evaluation of public dietary guideline awareness and use and a more in-depth understanding of dietary choice influences and behaviors are important considerations for dietary guideline development and promotion.

A mixed-method systematic review and meta-analysis of the influences of food environments and food insecurity on obesity in high-income countries

Obesity remains a serious public health concern in rich countries and the current obesogenic food environments and food insecurity are predictors of this disease. The impact of these variables on rising obesity trends is, however, mixed and inconsistent, due to measurement issues and cross-sectional study designs. To further the work in this area, this review aimed to summarize quantitative and qualitative data on the relationship between these variables, among adults and children across high-income countries. A mixed-method systematic review was conducted using 13 electronic databases, up to August 2021. Two authors independently extracted data and evaluated quality of publications. Random-effects meta-analysis was used to estimate the odds ratio (OR) for the association between food insecurity and obesity. Where statistical pooling for extracted statistics related to food environments was not possible due to heterogeneity, a narrative synthesis was performed. Meta-analysis of 36,113 adults and children showed statistically significant associations between food insecurity and obesity (OR: 1.503, 95% confidence interval: 1.432-1.577, p < .05). Narrative synthesis showed association between different types of food environments and obesity. Findings from qualitative studies regarding a reliance on energy-dense, nutrient-poor foods owing to their affordability and accessibility aligned with findings from quantitative studies. Results from both qualitative and quantitative studies regarding the potential links between increased body weight and participation in food assistance programs such as food banks were supportive of weight gain. To address obesity among individuals experiencing food insecurity, wide-reaching approaches are required, especially among those surrounded by unhealthy food environments which could potentially influence food choice.

Simulating Potential Associated Socio-Economic Determinants With Sustainable Food Security (A Macro-Micro Spatial Quantitative Model)

Improving sustainable food security status, nowadays, is an important challenge globally, especially in developing countries. The policy goal should be equity—everyone has the same opportunity to be food secure—rather than equality—everyone gets the same subsidy. Since the culture and socioeconomic status within a country vary from region to region, collapsing all areas into a unique region may introduce errors and inaccurate results, as most studies carried out. This study assesses the geographical pattern of association between food security and socioeconomic factors in urban areas in Iran using a nationally and regionally representative household consumption-expenditure survey from 2010 to 2018. The logistic regression model and big data are used to achieve this goal. The results show that a substantial number of households face food insecurity in urban areas in Iran. Also, different geographic regions have various salient factors that affect food insecurity. Aggregation tests confirmed that researchers should estimate separate models for different provinces, states, and districts to assess and monitor the food security status of a country instead of estimating a unique model for the whole of the country. Geographical disparities should be considered as an important issue before suggesting any catch-all policies for a country. The geo-locational factor of households is a key determinant of the association between socioeconomic factors and food security in urban areas in Iran. In sum, the practical suggestions for improving Iranian households' food security in urban areas are as follows: (1) Developing job opportunities for the head of household. (2) Enhancing the potential for self-employment. (3) Facilitating the study of children within households including providing inexpensive uniforms, books, and materials, especially for poor households. (4) Supporting young couples in terms of accessing to financial resources and providing inexpensive essential equipment of home for them; and (5) Introduction of the importance of dietary diversity and different foods which can be cooked by using these food ingredients within a household. Comparative case studies using similar methodologies can test if our results are generalizable.

A Community-Based Participatory Action Research with Women from Disadvantaged Populations: Strengths and Weaknesses of a Multiple Health Behaviour Change Intervention

Disadvantaged populations usually adopt risk behaviours, resulting in obesity and mental health-related disorders. Grounded in the socioecological model and self-determination theory, the aims were firstly to describe and implement a two-year multiple health behaviour change intervention, and secondly, to assess the strengths and weaknesses of the intervention. In total, 11 women from a disadvantaged population participated in this programme, which encompassed 117 sessions. Qualitative techniques were used to collect data and a thematic analysis was conducted. The variety of activities and the group-based intervention were the main strengths, and the decrease in attendance and the programme's tight schedule were the main weaknesses. This is the first intervention in a disadvantaged population mainly comprised of Roma women. The design described in detail and its assessment provide relevant knowledge to improve their health status and decrease inequalities. The practical implications for future research are useful for replicating interventions in similar contexts.

Significant Nutritional Gaps in Tibetan Adults Living in Agricultural Counties Along Yarlung Zangbo River

Background

Dietary intake and nutritional assessing data from a representative sample of adult population living in an agricultural zone on Tibet Plateau are still lacking nowadays. This study aimed to assess the daily dietary intakes and respective food sources in 552 local residents (≥ 18 years old, 277 men and 275 women) living in 14 agricultural counties along the Yarlung Zangbo River on Tibet Plateau.

Methods

Food consumption data were collected using a validated cultural-specific food frequency questionnaire that contained all local Tibetan foods and analyzed with three fixed factors: gender, age, and region. Nutrient intakes were calculated using Chinese food composition tables. Nutritional gaps and the percentages of participants who had inadequate and excessive nutrient intakes were calculated by estimated average requirement (EAR) cut-point methods.

Results

Compared with the dietary reference intakes, 68.4% of nutrient intakes were inadequate. Fiber, Ca, I, Zn, Se, and vitamin (Va, Vc, and folic acid) intakes appeared to be particularly deficient. The dietary energy intake was 7838.8 ± 537.1 KJ/d, with 78 and 84% of EAR values for men and women, respectively. The dietary intakes of most nutrients were below the estimated energy requirement/EAR or adequate intake values, while more than 70% of the participants had excessive intake of carbohydrate, especially the elderly (aged ≥ 51 years). The nutritional gap of Cu was more than 300%. Almost 100% of the participants was vulnerable to fiber, Se, and Va shortfalls due to the deficiency in sole food sources. The top five food sources of Se intake were highland barley (34.2%), meat (13%), rice (12.4%), eggs (12.2%), and cultural-specific beverages (7.8%). Eggs (42.1%), tubers (62.2%), vegetables (66.4%), and highland barley (49.7%) were the first contributors of Va, Ve, Vc, and folic acid, respectively.

Conclusion

The dietary intake of a large sample of Tibetan adult population living in agricultural counties of Tibetan Autonomous Region is alarmingly insufficient. Gender inequality is common, and regional difference is widespread due to rapid urbanization. Young Tibetan adults aged 18–30 years are particularly vulnerable to micronutrient shortfalls and currently facing the risk of nutrition-insecurity-related dietary inadequacy. The respondents who belong to the elderly category (≥51 years of age) are facing the risk of “double burden of malnutrition” characterized by the coexistence of undernutrition, including micronutrient deficiencies and overweight or obesity.

Improvements in Diet and Physical Activity-Related Psychosocial Factors Among African Americans Using a Mobile Health Lifestyle Intervention to Promote Cardiovascular Health: The FAITH! (Fostering African American Improvement in Total Health) App Pilot Study

BACKGROUND

African Americans continue to have suboptimal cardiovascular health (CVH) related to diet and physical activity (PA) behaviors compared with White people. Mobile health (mHealth) interventions are innovative platforms to improve diet and PA and have the potential to mitigate these disparities. However, these are understudied among African Americans.

OBJECTIVE

This study aims to examine whether an mHealth lifestyle intervention is associated with improved diet and PA-related psychosocial factors in African Americans and whether these changes correlate with diet and PA behavioral change.

METHODS

This study is a retrospective analysis evaluating changes in diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors (daily fruit and vegetable intake and moderate-intensity PA [MPA] per week) in 45 African American adults (mean age 48.7 years, SD 12.9 years; 33/45, 73% women) enrolled in the FAITH! (Fostering African American Improvement in Total Health) app pilot study. The intervention is a 10-week, behavioral theory-informed, community-based mHealth lifestyle intervention delivered through a mobile app platform. Participants engaged with 3 core FAITH! app features: multimedia education modules focused on CVH with self-assessments of CVH knowledge, self-monitoring of daily fruit and vegetable intake and PA, and a sharing board for social networking. Changes in self-reported diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors were assessed by electronic surveys collected at baseline and 28 weeks postintervention. Changes in diet and PA-related psychosocial factors from pre- to postintervention were assessed using paired 2-tailed t tests. The association of changes in diet and PA-related psychosocial variables with daily fruit and vegetable intake and MPA per week was assessed using Spearman correlation. Associations between baseline and 28-week postintervention changes in diet and PA-related psychosocial measures and CVH behaviors with covariates were assessed by multivariable linear regression.

RESULTS

Participants reported improvements in 2 subscales of diet self-regulation (decrease fat and calorie intake, P=.01 and nutrition tracking, P<.001), one subscale of social support for healthy diet (friend discouragement, P=.001), perceived barriers to healthy diet (P<.001), and daily fruit and vegetable intake (P<.001). Improvements in diet self-regulation (increase fruit, vegetable, and grain intake, and nutrition tracking) and social support for healthy diet (friend encouragement) had moderate positive correlations with daily fruit and vegetable intake (r=0.46, r=0.34, and r=0.43, respectively). A moderate negative correlation was observed between perceived barriers to healthy diet and daily fruit and vegetable intake (r=-0.25). Participants reported increases in PA self-regulation (P<.001). Increase in social support subscales for PA (family and friend participation) had a moderate positive correlation with MPA per week (r=0.51 and r=0.61, respectively).

CONCLUSIONS

Our findings highlight key diet and PA-related psychosocial factors to target in future mHealth lifestyle interventions aimed at promoting CVH in African Americans.

Mediating roles of psychological factors and physical and social environments between socioeconomic status and dietary behaviors among African Americans with overweight or obesity

The study aim was to examine the relationship between socioeconomic status (SES) and dietary behaviors through psychological and environmental mediators among African Americans with overweight or obesity. We conducted a cross-sectional study in 225 African American men and women. Data were analyzed using structural equation modeling with bootstrapping procedures. In the multiple mediation model, SES had a significant indirect effect on dietary behaviors through psychological and environmental factors (β = -.27; p = .01; 95% confidence interval [CI] = -0.59--0.10), but it had no significant direct effect on dietary behaviors (β = .06; p = .70; 95% CI = -0.21-0.39). SES had significant direct effects on psychological (β = .52; p = .01; 95% CI = 0.31-0.77) and environmental factors (β = -.40; p = .03; 95% CI = -0.53--0.25). Psychological (β = -.31; p = .02; 95% CI = -0.68--0.04) and environmental factors (β = .26; p = .01; 95% CI = 0.04-0.47) also showed significant direct effects on dietary behaviors. Thus, psychological and environmental factors mediated the relationship between SES and dietary behaviors in African Americans with overweight or obesity. Interventions that enhance psychological and environmental factors such as self-efficacy, perceived barriers to healthy eating, health perceptions, and physical and social environments may improve dietary behaviors among socioeconomically disadvantaged African Americans.

Associations Between Diet Quality and Dental Caries in Low-Income Women

BACKGROUND

The Healthy Eating Index 2015 (HEI-2015) is a diet quality measure of conformity of diet to the 2015-2020 Dietary Guidelines for Americans. This tool is being used increasingly to assess relationships between diet quality and health outcomes.

OBJECTIVE

The objective of this research was to investigate the relationships between diet quality as measured by HEI-2015 total and component scores and Decayed, Missing, Filled Teeth Index (DMFT) scores in low-income women.

DESIGN

In this cross-sectional study, low-income women were administered questionnaires and dental examinations on 1 occasion. The questionnaires included demographics, food frequency, and oral health questionnaires, and the US Adult Food Security Survey Module.

PARTICIPANTS/SETTINGS

Participants in this study were part of a larger research project-Impact of Diet and Nutrition on Dental Caries in Low-Income Women. For the larger research project, a total of 255 women aged 18 to 50 years with annual income <250% of the Federal Poverty Line were recruited from low-income housing units in Central Texas from June 1, 2018 to December 30, 2018. Of the 255 women, 28 underwent dental screenings but did not complete the questionnaires. Seven women were excluded because energy intakes exceeded 4,000 kcal/d. The final sample for the current analysis was 220 women who had completed their dental examinations and provided complete data.

MAIN OUTCOME MEASURES

The exposure was diet quality and the main outcome measure was DMFT score.

STATISTICAL ANALYSIS

Dental caries scores were calculated by addition of decayed, missing, and filled teeth. Descriptive statistics were conducted on the variables of age, race and ethnicity, education, annual household income, food security status, and frequency of brushing and flossing. Linear regression analysis was used to discern relationships between diet quality-as assessed by HEI-2015 total and component scores-and dental caries experience, adjusting for the covariates.

RESULTS

Caries in permanent teeth was present in 95.6% of participants. HEI-2015 total scores were inversely associated with dental caries. An increase of 1 point in total HEI-2015 score was accompanied by a decrease in DMFT score by 0.569 (P = .001). In addition, component scores for total vegetables (P = .001), greens and beans (P = .002), dairy (P = .004), refined grains (P = .001), and added sugars (P = .001) were inversely related to DMFT scores.

CONCLUSIONS

This research suggests that diet quality, as measured by the HEI-2015, is inversely associated with DMFT scores in low-income women. Future research is needed to investigate the influence of diet and nutrition on the integrity of oral health.

Diet-induced dysbiosis of the maternal gut microbiome in early life programming of neurodevelopmental disorders

The maternal gut microbiome plays a critical role in fetal and early postnatal development, shaping fundamental processes including immune maturation and brain development, among others. Consequently, it also contributes to fetal programming of health and disease. Over the last decade, epidemiological studies and work in preclinical animal models have begun to uncover a link between dysbiosis of the maternal gut microbiome and neurodevelopmental disorders in offspring. Neurodevelopmental disorders are caused by both genetic and environmental factors, and their interactions; however, clinical heterogeneity, phenotypic variability, and comorbidities make identification of underlying mechanisms difficult. Among environmental factors, exposure to maternal obesity in utero confers a significant increase in risk for neurodevelopmental disorders. Obesogenic diets in humans, non-human primates, and rodents induce functional modifications in maternal gut microbiome composition, which animal studies suggest are causally related to adverse mental health outcomes in offspring. Here, we review evidence linking maternal diet-induced gut dysbiosis to neurodevelopmental disorders and discuss how it could affect pre- and early postnatal brain development. We are hopeful that this burgeoning field of research will revolutionize antenatal care by leading to accessible prophylactic strategies, such as prenatal probiotics, to improve mental health outcomes in children affected by maternal diet-induced obesity.

The Influence of Rurality on Fruit and Vegetable Intake and BMI: Findings in Mississippi Are Not Consistent with Those at the National Level

Sixty percent of Americans have at least one chronic disease that is both diet-related and preventable. Those living in rural areas often experience a greater burden of disease than those who live near a city center. The purpose of this study is to determine the influence of rurality on fruit and vegetable (FV) consumption and BMI. Additionally, the study compares national results to those in Mississippi, a state with an aging population, and high rates of poverty, rurality, poor diet, and obesity. Data utilized were from the 2017 Behavioral Risk Factor Surveillance System. One-way analyses of covariance were performed to determine impact of rurality on nutritional intake and BMI, while controlling for age, income, education, race, and the presence of children in the home. At the national level, rurality had a significant impact on BMI, and the daily intake of fruit juice, fruits, dark green vegetables, French fries, potatoes, other vegetables, and total daily vegetable intake. BMI and nutritional intake of those living in Mississippi was significantly poorer than those living in other states. More research is needed to determine how to best facilitate access to healthy FVs for those living in rural communities.

Food and nutrient intake and diet quality among older Americans

OBJECTIVE

A suboptimal diet and nutritional deficiencies can have important influences on health with significant impact among older adults. This study aims to assess the presence of suboptimal dietary intake among older Americans and identify risk and protective factors influencing diet quality.

DESIGN

Cross-sectional secondary analysis.

SETTING

USA.

PARTICIPANTS

A nationally representative sample of 5614 community-dwelling older adults over age 54 in the Health and Retirement Study - Health Care and Nutrition Survey.

RESULTS

Overall, only 10·7 % of respondents had a good quality diet (Healthy Eating Index score 81 and above); the majority had diets considered poor or needing improvement. Less than 50 % of respondents met dietary guidelines and nutritional goals for most individual food groups and nutrients. Respondents with low socio-economic status, fewer psychosocial resources and those who had limited access to healthy food outlets were more likely to have a diet of suboptimal quality.

CONCLUSIONS

Efforts to remove identified barriers that put older adults at risk for poor nutrition and to provide resources that increase access to healthy food should be made to encourage healthy eating and enhance diet quality.

Does the High Prevalence of Vitamin D Deficiency in African Americans Contribute to Health Disparities?

African Americans have higher incidence of, and mortality from, many health-related problems than European Americans. They also have a 15 to 20-fold higher prevalence of severe vitamin D deficiency. Here we summarize evidence that: (i) this health disparity is partly due to insufficient vitamin D production, caused by melanin in the skin blocking the UVB solar radiation necessary for its synthesis; (ii) the vitamin D insufficiency is exacerbated at high latitudes because of the combination of dark skin color with lower UVB radiation levels; and (iii) the health of individuals with dark skin can be markedly improved by correcting deficiency and achieving an optimal vitamin D status, as could be obtained by supplementation and/or fortification. Moderate-to-strong evidence exists that high 25-hydroxyvitamin D levels and/or vitamin D supplementation reduces risk for many adverse health outcomes including all-cause mortality rate, adverse pregnancy and birth outcomes, cancer, diabetes mellitus, Alzheimer's disease and dementia, multiple sclerosis, acute respiratory tract infections, COVID-19, asthma exacerbations, rickets, and osteomalacia. We suggest that people with low vitamin D status, which would include most people with dark skin living at high latitudes, along with their health care provider, consider taking vitamin D3 supplements to raise serum 25-hydroxyvitamin D levels to 30 ng/mL (75 nmol/L) or possibly higher.

Sociodemographic Differences in the Dietary Quality of Food-at-Home Acquisitions and Purchases among Participants in the U.S. Nationally Representative Food Acquisition and Purchase Survey (FoodAPS)

Insufficient research has explored whether sociodemographic differences in self-reported, individual-level diet quality are similarly reflected by grocery purchase quality. This cross-sectional analysis of n = 3961 U.S. households from the nationally representative Food Acquisition and Purchase Survey (FoodAPS) compared Healthy Eating Index (HEI)-2015 scores from 1 week of food-at-home acquisitions across self-reported demographic factors (race/ethnicity, Supplemental Nutrition Assistance Program (SNAP) participation, food security, and household-level obesity status). Multivariable-adjusted, survey-weighted regression models compared household HEI-2015 scores across sociodemographic groups. Respondents were primarily White and female, with a mean age of 50.6 years, 14.0% were food insecure, and 12.7% were SNAP-participating. Mean HEI-2015 scores were 54.7; scores differed across all sociodemographic exposures (p < 0.05). Interactions (p < 0.1) were detected between SNAP participation and (1) food insecurity and (2) household-level obesity, and race/ethnicity and (1) household-level obesity. HEI-2015 scores were higher among food secure, non-SNAP households than among food insecure, SNAP-participating households (53.9 ± 0.5 vs. 50.3 ± 0.7, p = 0.007); non-SNAP households without obesity had significantly higher HEI-2015 scores than other households. Household-level obesity was associated with lower HEI-2015 scores in White (50.8 ± 0.5 vs. 52.5 ± 0.7, p = 0.046) and Black (48.8 ± 1.5 vs. 53.1 ± 1.4, p = 0.018) but not Hispanic households (54.4 ± 1.0 vs. 52.2 ± 1.2, p = 0.21). Sociodemographic disparities in household HEI-2015 scores were consistent with previous research on individual-level diet quality.

Effects of a food hub initiative in a disadvantaged community: A quasi-experimental evaluation

A quasi-experiment evaluated a food hub's (FH) impact in a low-income/low-access (food desert) setting on fruit and vegetable (F&V) intake, diet quality, kilocalories, perceived food environment, BMI, and farmers' market shopping versus a matched community (n = 265 FH, n = 262 Comparison). Comparison shoppers had better baseline perceptions of their food environment, but FH shoppers improved significantly more than Comparison shoppers. Comparison shoppers significantly increased F&V intake versus FH shoppers. Effects were not significant for other diet outcomes, BMI, or farmers' market shopping. Factors besides spacial access to healthy food need consideration to address dietary intake and obesity in disadvantaged communities.

Different Associations of Socioeconomic Status on Protein Intake in the Korean Elderly Population: A Cross-Sectional Analysis of the Korea National Health and Nutrition Examination Survey

Socioeconomic status affects food choices. This study examined the relationships between socioeconomic status (SES) and animal and plant protein intake in the Korean elderly population whose protein intake is insufficient. We used cross-sectional data from 3512 Koreans aged 60 years or older, who had participated in the Nutrition Survey of the 2013-14 Korea National Health and Nutrition Examination Survey (KNHANES). One day 24-h recall data was used to estimate the daily total, animal, and plant protein intake. Household income and educational attainment were assessed by trained interviewers. After making adjustment, household income was positively associated with animal protein intake with a statistical significance in females (p = 0.030) and with a marginal significance in males (p = 0.069). However, plant protein intake did not show any significant association. In both sexes, educational attainment was positively associated with animal protein intake (p = 0.007 for males, p = 0.001 for females). Association of educational attainment with plant protein intake was negative in males (p = 0.037) and non-significant in females. (p = 0.945). High SES was associated with higher total protein intake and animal protein intake in the Korean elderly. Health policies and nutrition education are needed to improve protein intake of the vulnerable Korean elderly with low SES.

A Longitudinal Assessment of Diet Quality and Risks Associated with Malnutrition in Socioeconomic and Racially Diverse Adults

Little is known about the effects of diet quality through adulthood and its association with malnutrition later in life. The first research objective was to evaluate diet quality assessed by Mean Adequacy Ratio (MAR) of United States African American and White adults (n = 2066), examined at baseline and two follow-up waves in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. The sample was split into cohorts by age at study baseline: Younger, <50, and older, ≥50 years. The second objective was to assess the association of MAR and risk for malnutrition in adults who were ≥60 years at wave 4 (n = 746). The Mini Nutritional Assessment was used to determine risk for malnutrition. At each of the three study waves, 17 micronutrients from two 24 h dietary recalls were used to calculate MAR. Over 13 years MAR changed minimally in the younger cohort as they aged from early to middle adulthood. In contrast, a statistically significant decline in MAR was observed for the older cohort between baseline (2004–2009) and wave 4 (2013–2017), with a greater degree of worsening at low energy levels. The risk for malnutrition was significantly associated with consuming a diet low in energy, lower protein as a percent of energy at baseline, as well as being food insecure, a current smoker, and having income <125% poverty. The risk for malnutrition was not associated with a change in protein intake in years prior to age 60, change in MAR scores across waves, MAR at wave 4, age, sex, race, or having hypertension or diabetes. These longitudinal study findings revealed that diet quality was not predictive of risk for malnutrition.

Predictors of Dietary Diversity of Indigenous Food-Producing Households in Rural Fiji

Fiji, like other Pacific Islands, are undergoing economic and nutrition transitions that increase the risk of noncommunicable diseases (NCDs) due to changes of the food supply and dietary intake. This study aimed to examine dietary diversity (DD) in indigenous food-producing households in rural Fiji. Surveys were conducted with households from the Nadroga-Navosa, Namosi and Ba Provinces of Western Fiji in August 2018. Participants reported on foods consumed in the previous 24 h per the Household Dietary Diversity Score. Data was analysed using multinomial logistic regression. Of the 161 households, most exhibited medium DD (66%; M = 7.8 ± 1.5). Commonly consumed foods included sweets (98%), refined grains (97%) and roots/tubers (94%). The least consumed foods were orange-fleshed fruits (23%) and vegetables (35%), eggs (25%), legumes (32%) and dairy (32%). Households with medium DD were more likely to be unemployed (OR 3.2, p = 0.017) but less likely to have ≥6 occupants (OR = 0.4, p = 0.024) or purchase food ≥2 times/week (OR = 0.2, p = 0.023). Households with low DD were more likely to have low farm diversity (OR = 5.1, p = 0.017) or be unemployed (OR = 3.7, p = 0.047) but less likely to have ≥6 occupants (OR = 0.1, p = 0.001). During nutrition transitions, there is a need for public health initiatives to promote traditional diets high in vegetables, fruits and lean protein and agricultural initiatives to promote farm diversity.

An Examination of Demographic and Psychosocial Factors, Barriers to Healthy Eating, and Diet Quality Among African American Adults

A healthy diet is associated with lower risk of chronic disease. African Americans generally have poor diet quality and experience a higher burden of many chronic diseases. We examined the associations of demographic and psychosocial factors and barriers to diet quality among African American adults. This cross-sectional study included 100 African American adults in a southeastern metropolitan area. Psychosocial factors (social support, self-efficacy), and barriers to healthy eating were assessed with validated measures. Diet quality was assessed using the Healthy Eating Index (HEI-2010). Nested linear regressions were used to examine the association between the variables of interest and HEI scores. Participants reported having social support (M (mean) = 2.0, SD (standard deviation) = 0.6, range 0⁻3), high levels of self-efficacy (M = 3.1, SD = 0.7, range 1⁻4), and low barriers (M = 1.4, SD = 0.6, range 0⁻4) to engage in healthy eating but total mean HEI scores needed improvement (M = 54.8, SD = 10.9, range 27.1⁻70.0). Participants consumed significantly higher empty calories and lower whole fruits, dairy, and total protein foods than the national average. Barriers to healthy eating (b = -12.13, p = 0.01) and the interaction between age and barriers (b = 0.25, p = 0.02) were most strongly associated with lower HEI scores. Younger African Americans with the highest barriers to healthy eating had the lowest HEI scores. Culturally appropriate interventions targeting empty calories, barriers to healthy eating, and knowledge of the Dietary Guidelines for Americans are needed for African Americans.

Title: efficacy of a food parenting intervention for mothers with low income to reduce preschooler's solid fat and added sugar intakes: a randomized controlled trial

Background

Few interventions have shown efficacy to influence key energy balance behaviors during the preschool years.

Objective

A randomized controlled trial (RCT) was used to evaluate the efficacy of Food, Fun, and Families (FFF), a 12 week authoritative food parenting intervention for mothers with low-income levels, to reduce preschool-aged children’s intake of calories from solid fat and added sugar (SoFAS).

Methods

Mothers were randomly assigned to receive FFF (n = 59) or to a delayed treatment control (n = 60). The primary outcome was children’s daily energy intake from SoFAS at the end of the 12 week intervention, controlling for baseline levels, assessed by 24-h dietary recalls. Secondary outcomes included children’s daily energy intake, children’s BMI z-scores, and meal observations of maternal food parenting practices targeted in FFF (e.g. providing guided choices).

Results

Participating mothers were predominantly African American (91%), with 39% educated beyond high school and 66% unemployed. Baseline demographics and child SoFAS intakes did not differ by group. Lost to follow-up was 13% and did not differ between groups. At post-intervention, FFF children consumed ~ 94 kcal or 23% less daily energy from SoFAS than children in the control group, adjusting for baseline levels (307.8 (95%CI = 274.1, 341.5) kcal vs. 401.9 (95%CI = 369.8, 433.9) kcal, FFF vs. control; p < 0.001). FFF mothers also displayed a greater number of authoritative parenting practices when observed post-intervention with their child at a buffet-style meal (Wilcoxon z = − 2.54, p = 0.012). Neither child total daily energy intake nor BMI z-scores differed between groups post-intervention.

Conclusions

Findings demonstrate the initial efficacy of an authoritative food parenting intervention for families with low-income to reduce SoFAS intake in early childhood. Additional research is needed to evaluate longer-term effects on diet and growth.

Trial registration

Retrospectively registered at ClinicalTrials.gov: #NCT03646201.