Home food environment and associations with weight and diet among U.S. adults: a cross-sectional study

Burden and trend of dietary risk-related colorectal cancer in China and its provinces: findings from the Global Burden of Disease Study 2019

OBJECTIVES

The objective of this experiment was to evaluate the spatial pattern and temporal trend of colorectal cancer (CRC) burden attributed to dietary risk factors in China from 1990 to 2019 using data from the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019.

METHODS

Numbers and age-standardised rates of deaths, disability-adjusted life years (DALYs) and corresponding average annual percentage change (AAPC) were determined. The joinpoint regression analysis was used to assess the temporal trends of CRC deaths and DALYs from 1990 to 2019.

RESULTS

In China, the number of diet-attributable CRC deaths and DALYs in 2019 were 90.41 (95% uncertainty interval: 65.69, 114.67) and 2234.06 (1609.96, 2831.24) per-1000 population, marking 2.05% and 1.68% annual increases since 1990, respectively. The region with the highest increase in age-standardised rates (ASRs) of diet-related CRC deaths and DALYs was in Taiwan with an AAPC of 2.00% (1.51, 2.48), whereas the highest decline in ASRs of CRC deaths and DALYs was observed in Hong Kong with an AAPC of -0.63% (-0.90, -0.35) (all P < 0.05). Nationally, men suffered higher CRC deaths and DALY burdens attributable to dietary risks than did women. Regarding the specific diet group, diets low in calcium, milk, and whole grains contributed to CRC deaths and DALYs the most.

CONCLUSIONS

Diet is an important contributor to increasing CRC burden in China. Necessary measures should be taken to kerb the growing burden attributed to dietary factors, particularly in males and in regions with middle Socio-demographic Index or lower.

Different Dimensions of the Home Food Environment May Be Associated with the Body Mass Index of Older Adults: A Cross-Sectional Survey Conducted in Beijing, China

OBJECTIVE

The objective of this study was to evaluate the home food environment of the elderly in Beijing and analyze its association with the body mass index (BMI) of the elderly, as well as to provide recommendations for improving the home food environment for the elderly.

METHODS

This study was conducted in Beijing, China, in 2019. The participants were 1764 elderly individuals aged 65 to 80, recruited from 12 communities through a multistage stratified random sampling method. The study involved the use of questionnaire surveys to gather data on participants' demographics, the availability of various foods in their households, and their living conditions. Socioeconomic status (SES) was evaluated based on their educational level, occupation, and income level. Height and weight measurements were taken to calculate BMI. We conducted both univariate analysis and multiple linear regression analysis to evaluate the relationship between the home food environment and BMI.

RESULTS

A total of 1800 questionnaires were distributed, of which 1775 were retrieved, resulting in a questionnaire recovery rate of 98.6%. Among these, 1764 questionnaires were deemed valid, corresponding to a questionnaire validity rate of 99.4%. The participants had a mean age of 69.7 ± 4.3 years old, over 40% of whom were overweight or obese. In terms of low-energy/high-nutrient-density foods, the most readily available items were fresh vegetables (95.6%), followed by coarse grains (94.1%), fresh fruits (90.4%), and dairy products (83.6%). Among high-energy/low-nutrient-density foods, preserved foods were the most available (51.9%), followed by salted snacks (40.6%), sugary beverages (28.2%), and fried foods (9.4%). Approximately 7.3% of participants lived alone. Elderly individuals with higher SES had a lower BMI compared to those with medium to low SES (25.9 vs. 26.5, 25.9 vs. 26.4, p < 0.05). Those living alone had a higher BMI than those who did not (27.2 vs. 26.2, p = 0.001). After controlling for potential confounding variables, older adults with high SES exhibited a BMI reduction of 0.356 kg/m2 (p = 0.001), whereas those living alone exhibited an increase in BMI of 1.155 kg/m2 (p < 0.001). The presence of preserved foods at home was linked to a BMI increase of 0.442 kg/m2 (p = 0.008).

CONCLUSION

This study underscores the significant impact of family SES, living conditions, and the availability of preserved foods on the BMI of elderly individuals.

Vegetable and Fruit Intake Variety and Cardiovascular Health and Mortality: A Systematic Review and Meta-Analysis of Observational Studies

INTRODUCTION

A multitude of evidence supports the consumption of a higher quantity of vegetables and fruits for their cardiovascular benefits. Nonetheless, the extent to which variety is associated with cardiovascular health remains unclear.

OBJECTIVE

To conduct a systematic review and meta-analysis of observational studies (prospective cohort and cross-sectional studies) assessing the role of a variety of vegetable and fruit consumption in cardiovascular morbidity and mortality in adults.

DATA SOURCES

MEDLINE-PubMed, Cochrane databases, and reference lists were searched through March 2023.

DATA EXTRACTION

Two independent reviewers extracted data and assessed the risk of bias (National Heart, Lung, and Blood Institute Tool and Newcastle-Ottawa Scale).

DATA ANALYSIS

Data were pooled (fixed and random [DerSimonian and Laird] effects for <5 and ≥5 study comparisons, respectively), and heterogeneity was assessed using the Cochran Q statistic and quantified (I2 statistic). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the overall certainty of the evidence. Five cross-sectional (n = 45,761) and seven prospective studies (n = 253,422) met the eligibility criteria. Greater variety of vegetable and fruit consumption was prospectively related to decreased all-cause mortality (risk ratio, 0.89 [95% CI, 0.82-0.97], seven study comparisons, n = 196,925), while no significant associations were observed with assessed cardiovascular-related mortality or morbidity. For all outcomes, the certainty of the evidence was graded as "low" or "very low" owing to inconsistency and/or imprecision.

CONCLUSIONS

Overall, this study shows that greater variety in vegetable and fruit consumption may reduce all-cause mortality and highlights the need for additional studies with a higher degree of evidence to better understand its role in cardiovascular health.

Parent meal self-efficacy and practices in households with healthy home food environments in the face of economic hardship

Some families who experience economic hardship demonstrate remarkable strength and resourcefulness to sustain a healthy home food environment. This ability to navigate economic barriers could be associated with parent meal practices that promote children's healthful dietary intake. Therefore, this study aimed to examine 1) whether parent meal self-efficacy and practices were associated with economic assistance status and home fruit and vegetable (FV) availability and 2) how parent meal self-efficacy and practices differed by home FV availability and economic assistance status. Analyses utilized baseline data from 274 parent/child dyads from two childhood obesity prevention trials: HOME Plus (urban) and NU-HOME (rural). Parents in households with high FV availability (regardless of economic assistance) had significantly higher self-efficacy in preparing healthy foods, family dinner routines, frequency of child's plate being half filled with FV, frequency of family dinner and breakfast, and lower frequency of purchasing dinner from fast food restaurants. Economic assistance was not associated with parent meal self-efficacy and practices. Four family groups were created and defined by economic assistance (yes/no) and home FV availability (high/low). About 31% of families that received economic assistance and had high home FV availability were food insecure. Families (n = 39) receiving economic assistance and having high home FV availability had greater frequency of family dinners compared to those in households with economic assistance and low home FV availability (n = 47) (p = 0.001); no other parent meal self-efficacy or practices differed between groups. Our findings suggest some families can maintain healthy home food environments despite economic hardship and frequent family dinners may be an important strength for these families. More research is needed to investigate asset-based models to understand the family strengths that enable them to thrive during difficult times.

Race/Ethnicity Modifies the Relationship Between Diet Quality at the Home- and Individual-Levels and Weight Status Among African American and Hispanic/Latinx Households With Preschool-Age Children

Background: Higher obesity prevalence and poorer diet quality disproportionately impacting groups based on income and race/ethnicity may be partially attributed to the home food environment. This study examined home- and individual-level diet quality with weight status among racially/ethnically diverse households. Methods: This cross-sectional study included African American (AA) and Hispanic/Latinx (H/L) households with preschool-age children (n = 97). Home-level diet quality was based on comprehensive home food inventories and individual-level diet quality was based on 24-hour dietary recalls; scores were estimated with the Healthy Eating Index. Child and adult appropriate weight categories based on BMI were estimated with measured heights and weights. Multiple linear regression models (independent variable: weight status, outcome: diet quality scores) with an interaction term for weight status and race/ethnicity and adjusting for potential confounding factors were used to estimate adjusted mean diet quality scores. Postestimation pairwise comparisons of these scores were used to look for within and between group differences by weight status and race/ethnicity. Results: Home-level diet quality scores were significantly higher among H/L households compared to AA counterparts regardless of weight status. AA parents with BMI <30 and AA children with BMI <85th percentile had poorer individual-level diet quality scores compared to AA parents and children of lower weight status and all H/L parents and children. Conclusions: These findings offer evidence that race/ethnicity modifies the relationship between diet quality and weight among AA and H/L households. Future research needs to examine the distinctive ways race/ethnicity shapes the relationship between weight and diet quality in these households.

The Association between Food Security Status and the Home Food Environment among a Sample of Rural South Carolina Residents

Prior research suggests that food security status may have an effect on the home food environment. Further, the literature suggests that food access factors may function to influence said relationship. The purpose of this research is to fill a gap in the literature on this relationship, as well as to identify potential food access effect modifiers. This research employs linear mixed effects modeling with a random intercept variable (zip codes). Eleven food access variables are included in regression analyses and are tested as potential effect modifiers in the association between food security status and the home food environment. Food security status is significantly associated with the home food environment (95% CI = 0.1-1.38) in the unadjusted model. In the adjusted model, food pantry usage is found to be a significant effect modifier on the association between food security status and the home food environment. This research concludes that food security status has a significant but disparate effect on the home food environment depending on participant food pantry usage. Practical implications from this research would be for relevant stakeholders to potentially improve rural food pantry access in order to increase the home food environment among rural and food insecure populations.

Preliminary Validation of Digital Photography to Assess the Home Food Environment

The home food environment (HFE), the availability and accessibility of foods and food products within the home, has a strong influence on healthy eating behaviors. Studies assessing the HFE commonly utilize a home food inventory (HFI) for data collection. However, this approach tends to be burdensome for participants. This study validated a low-burden digital photo method for assessing the home food environment and confirmed that this method is preferred by participants. Study participants completed an HFI, submitted photos of household foods, then identified preference for the HFI or photo reporting method. Researchers completed an HFI based on each participant's photo submissions. Researcher-to-participant and researcher-to-researcher comparisons were made through ANOVA and randomized block analyses to determine concurrent validity and inter-rater reliability. Method preference was assessed using the Z-test. The participant group (N = 53) was predominantly female (68%), young adult (90.5%), and Hispanic or Latino (71.7%). Concurrent validity was initially moderate (ĸ = 0.54); adjustments yielded substantial agreement (ĸ = 0.61). The inter-rater reliability (p = 0.98) demonstrated significant consistency among reviewers. The photo-documentation method was found to be valid and preferred (p = 0.01) for reporting on the HFE. The photo method can be used advantageously to collect quality data.

Contextualizing the Neural Vulnerabilities Model of Obesity

In recent years, investigators have focused on neural vulnerability factors that increase the risk of unhealthy weight gain, which has provided a useful organizing structure for obesity neuroscience research. However, this framework, and much of the research it has informed, has given limited attention to contextual factors that may interact with key vulnerabilities to impact eating behaviors and weight gain. To fill this gap, we propose a Contextualized Neural Vulnerabilities Model of Obesity, extending the existing theory to more intentionally incorporate contextual factors that are hypothesized to interact with neural vulnerabilities in shaping eating behaviors and weight trajectories. We begin by providing an overview of the Neural Vulnerabilities Model of Obesity, and briefly review supporting evidence. Next, we suggest opportunities to add contextual considerations to the model, including incorporating environmental and developmental context, emphasizing how contextual factors may interact with neural vulnerabilities to impact eating and weight. We then synthesize earlier models and new extensions to describe a Contextualized Neural Vulnerabilities Model of Obesity with three interacting components-food reward sensitivity, top-down regulation, and environmental factors-all within a developmental framework that highlights adolescence as a key period. Finally, we propose critical research questions arising from the framework, as well as opportunities to inform novel interventions.

Examining the associations between mothers' motivation to regulate their own eating behaviors, food parenting practices and perceptions of their child's food responsiveness

Based on the Self-Determination Theory, this study examined: 1) how mothers' autonomous and controlled motivation to regulate their own eating behaviors relate to their food parenting practices, and 2) whether and how child food responsiveness (i.e., reactivity and attraction to food) interact with mothers' motivation to predict maternal food parenting practices. Participants were 296 French Canadian mothers of at least one child aged between 2 and 8 years old. Results of partial correlation analyses (controlling for demographics and controlled motivation) showed that maternal autonomous motivation to regulate their own eating behaviors was positively related to autonomy-promoting (i.e., child involvement) and structure-based (i.e., modeling, creating a healthy environment, monitoring) food parenting practices. In contrast, controlling for demographics and autonomous motivation, maternal controlled motivation was positively associated with food-related practices based on coercive control (i.e., the use of food to regulate the child's emotions, the use of food as a reward, pressure to eat, restriction for weight reasons, and restriction for health reasons). Furthermore, the child's food responsiveness was found to interact with mothers' motivation to regulate their own eating behaviors in the prediction of maternal food parenting practices such that mothers with high autonomous motivation or low controlled motivation were found to react with more structure-based (i.e., creating a healthy environment) and autonomy-based (i.e., child involvement) practices, as well as less controlling practices (i.e., the use of food to regulate the child's emotions), to a child who is highly responsive to food. In conclusion, findings suggest that guiding mothers toward developing a more autonomous and less controlled motivation to regulate their own eating behaviors might help them adopt more autonomy-promoting and structure-based and less controlling feeding practices, especially with children who are highly responsive to food.

Perceived challenges and strategies to achieve Canada's Food Guide recommendation to "Cook more often": Findings from parents of young children

Unhealthy diets are detrimental to health, but home meal preparation is associated with better diet quality. Among a sample of parents of children aged 2-12, this study aimed to 1) explore perceived challenges and strategies to meeting the 2019 Canada's Food Guide recommendation of "Cook more often". From October 2019 to January 2020, 8 focus groups were conducted with 40 parents (73% mothers; 78% white) from Southwestern Ontario, Canada. Sessions were audio-recorded and transcribed verbatim. A hybrid thematic approach with inductive and deductive data analysis was used. Reported challenges included time constraints, picky eating, lacking cooking skills, high price of some fresh ingredients, school restrictions on meals at school, and the influence of children's peers on food choices, mainly unhealthy snacks. Reported strategies to mitigate some challenges included planning and preparing meals ahead of time, using technology or services to make meal planning and grocery shopping more convenient, using devices and kitchen instruments, such as Crockpot®, to make cooking faster, receiving help from spouse or child(ren), and acknowledging that foods perceived as less healthful in moderation can be included in meal preparation. These findings can help inform interventions and educational campaigns to support cooking among families with young children.

Can Ordering Groceries Online Support Diet Quality in Adults Who Live in Low Food Access and Low-Income Environments?

During the COVID-19 pandemic, U.S. food assistance programs allowed the use of program benefits to order groceries online. We examined relationships between the food environment, food assistance, online grocery ordering, and diet quality among adults from one low-income, low food access community in Northeastern Connecticut during the pandemic. Via online survey, adults (n = 276) reported their perceived home and store food environments, food assistance participation, whether they ordered groceries online, and consumption frequency and liking of foods/beverages to calculate diet quality indices. Those who ordered groceries online (44.6%) were more likely to participate in food assistance programs and report greater diet quality. Perceived healthiness of store and home food environments was variable, with the ease of obtaining and selecting unhealthy foods in the neighborhood significantly greater than healthy foods. Healthier perceived home food environments were associated with significantly higher diet qualities, especially among individuals who participated in multiple food assistance programs. Ordering groceries online interacted with multiple measures of the food environment to influence diet quality. Generally, the poorest diet quality was observed among individuals who perceived their store and home food environments as least healthy and who did not order groceries online. Thus, ordering groceries online may support higher diet quality among adults who can use their food assistance for purchasing groceries online and who live in low-income, low-access food environments.

The energy density of meals and snacks consumed by young Australian adults (18-30 years old) are influenced by preparation location but not screen use nor social interactions: findings from the MYMeals wearable camera study

The present study examined the association of contextual factors (social and food preparation location) with the energy density of meals and snacks consumed in a sample of young Australian adults (18-30 years old) identified using wearable camera technology. Over three consecutive days, a subsample of young adults wore a wearable camera that captured images in 30 s intervals. Eating episodes from 133 participants were annotated for preparation location and social context (covering social interaction and screen use). Over the same period, participants completed daily 24 h recalls. The nutritional composition of meals and snacks was calculated by matching the items identified in the camera to the 24 h recall using time and date stamps. Self-reported data (weight and height) was used to calculate body mass index and (residential postcode) to assign socio-economic status. The association of context and demographic factors with energy density was determined using a mixed linear regression model employing the bootstrap method with bias-corrected and accelerated. In total, 1817 eating episodes were included in the analysis (n 8 preparation unclear and n 15 food components could not be identified excluded). Food prepared within the home was 1⋅1 kJ/g less energy-dense than other preparation locations. Lunches (CI -1⋅7 to -0⋅3) and dinners (CI -1⋅6 to -0⋅5) were both 1⋅0 kJ/g lower in energy density than breakfasts. Snacks were 3⋅5 kJ/g (CI 2⋅8-4⋅1) more energy-dense than breakfasts. Food prepared outside the home and food consumption during snacking appear to be adversely contributing to energy-dense food intake.

Family Social Support and Weight-Related Behaviors of School-Age Children: An Exploratory Analysis

Families are a key provider of support that may encourage positive weight-related behaviors. Yet little is known about the relation of family support to children’s performance of weight-related behaviors. Mothers (N = 524) who completed an online survey were categorized as having low, moderate, or high family support for fruit/vegetable intake, breakfast intake, limiting sugar-sweetened beverage intake, physical activity, limiting sedentary screentime, and sleep. ANOVA revealed that children in families with high support for breakfast ate this meal significantly more often. Additionally, children in families with low support for limiting sugar-sweetened beverages had significantly greater intake. Surprisingly, families with moderate support for physical activity and sleep tended to have children with lower physical activity level, sleep duration, and sleep quality, and fewer days/week with set bedtimes than those with low and high support. Binomial logistic regression revealed that high family support for eating breakfast, limiting sugar-sweetened beverages, and getting sufficient sleep had greater odds of meeting recommendations for these behaviors. Findings suggest that greater family support for healthy weight-related behaviors tends to be associated with children’s performance of these behaviors. Future interventions should further examine the impact of different types of family support on weight-related behaviors to better understand this complex interplay.

Avaliação dos produtos alimentícios adquiridos por adultos com obesidade e o grau de processamento dos alimentos

Introdução: O aumento da obesidade está relacionado a mudanças no padrão de aquisição e de consumo de produtos alimentícios ultraprocessados em detrimento de alimentos in natura e minimamente processados. O objetivo do presente estudo foi investigar a prevalência de obesidade em um território adstrito à Unidade Básica de Saúde, em município de pequeno porte, e avaliar os produtos alimentícios adquiridos pelos indivíduos com obesidade de acordo com o grau de processamento. Métodos: Estudo analítico transversal dividido em duas etapas. Na primeira, foi investigado o índice de massa corporal (IMC) de 533 indivíduos da cidade de pequeno porte. Selecionou-se 60 indivíduos para a segunda etapa, em que foram investigados determinantes do perfil nutricional, tais como aquisição de alimentos e gasto com alimentação. Resultados: Na primeira etapa, foi encontrada a prevalência de 30,39% de obesidade. Na segunda, não houve diferença significativa na aquisição de alimentos por grau de processamento. No entanto, chama atenção a quantidade adquirida de processados e ultraprocessados. Mais de 18% dos entrevistados relataram omitir o café da manhã e quase 22% disseram almoçar no trabalho. Não houve diferenças nos gastos totais, por local de compra e na proporção de gastos com alimentação em relação à renda familiar e às categorias de obesidade. Conclusões: A prevalência de obesidade no distrito estudado é alta, tendo em vista sua população. Sugerimos que essa prevalência possa ser influenciada pela aquisição de ultraprocessados, pela alimentação fora do lar e pela omissão do café da manhã.

Cardiovascular disease burden attributable to dietary risk factors from 1990 to 2019: A systematic analysis of the Global Burden of Disease study

BACKGROUND AND AIMS

Dietary risks have always been a major risk factor for cardiovascular diseases (CVDs), especially in young people. This article aimed to provide an updated and comprehensive view of the spatial, temporal and sexual heterogeneity in diet-attributable CVD burdens from 1990 to 2019.

METHODS AND RESULTS

Data on diet-attributable CVD burdens were extracted from the Global Burden of Disease (GBD) Study 2019. Numbers and age-standardized rates (ASRs) of deaths, disability-adjusted life years (DALYs) and corresponding estimated annual percentage change (EAPC) were determined. Globally, the number of diet-attributable CVD deaths and DALYs in 2019 were 6.9 million and 153.2 million, marking 43.8% and 34.3% increases since 1990, respectively. However, ASRs of death and DALYs have declined over time. The regions with the highest ASRs of diet-related CVD deaths and DALYs were in Central Asia, whereas the lowest ASRs of CVD deaths and DALYs were observed in the high-income Asia Pacific region. Globally, men suffered higher death and DALY burdens than women. Ischemic heart disease and stroke were the leading causes of CVD deaths and DALYs, globally. Regarding the specific diet group, diets low in whole grains, high in sodium, low in fruits, low in nuts and seeds, low in vegetables and low in seafood omega-3 fatty acids contributed to CVD deaths and DALYs the most. Dietary risks accounted for a higher proportion in people aged less than 65 years old.

CONCLUSIONS

Diet-attributable CVDs threaten public health, particularly in low SDI countries and younger generations. As diet-related CVDs are nation-specific, the prioritization of public health interventions should be evidence-based.

The association of social and food preparation location context with the quality of meals and snacks consumed by young adults: findings from the MYMeals wearable camera study

PURPOSE

This study examined the association of social contexts and food preparation location with the quality of meals and snacks (predominately from the five food groups (FFG) versus discretionary foods) in a sample of young Australian adults (18-30 years old) using wearable camera technology.

METHODS

A sub-sample from the cross-sectional MYMeals study wore a wearable camera that captured images every 30 s for three consecutive days. Eating episodes from 133 participants (55% female) were classified across 4 domains: food quality (observed proportion of FFG and discretionary items), preparation location, social interaction, and screen use. Socio-economic status (SES) was assigned using residential postcode and gender self-reported. Associations of contexts and demographic factors with food quality stratified by meal type were determined using mixed binary logistic regression models.

RESULTS

Of the 1840 eating episodes identified, 1775 were included in analysis (n = 8 preparation location and n = 57 food components that could not be identified were excluded). Food prepared at home was more likely to be from the FFG at lunch (OR = 4.8 95% CI 2.7-8.6), dinner (OR = 14.8 95% CI 7.6-28.6), and snacks (OR = 3.2 95% CI 2.2-4.8). Participants from higher SES areas were more likely to consume breakfasts (OR = 3.2 95% CI 1.4-7.4) and lunches (OR = 1.9 95% CI 1.0-3.7) predominately from the FFG. Females were more likely to consume lunches (OR = 2.0 95% CI 1.1-3.8) that was largely from the FFG. Social interaction and screen use were not associated with meal or snack quality.

CONCLUSION

Wearable cameras have verified the importance of addressing meals and snacks prepared outside of home as an important contributor of discretionary food.