Trends in fruit and vegetable consumption among adults in 16 US states: Behavioral Risk Factor Surveillance System, 1990-1996

Sex Differences in Salmonellosis Incidence Rates-An Eight-Country National Data-Pooled Analysis

Background: There are few studies on sex differences in the incidence rates (IR) for salmonellosis over several countries by age and time period. The purpose of this study was to explore the extent and consistency of the sex and age-specific differences. Methods: We analyzed national data from eight countries between 1994 and 2016. We computed country-specific male to female incidence rate ratios (IRRs) for each age group and pooled the data using meta-analytic methods. Variations of the IRRs by age, country and time period were evaluated using meta-regression. Results: The pooled male to female incidence RRs for ages 0–1, 1–4, 5–9 and 10–14, were 1.04 (1.02–1.06), 1.02 (1.01–1.03), 1.07 (1.05–1.08) and 1.28 (1.23–1.33), respectively. For the ages 15–44 and 45–64, the incidence rates were significantly higher in females. Meta-regression analyses indicate that age groups contributed most of the variation in the male to female IRRs. Conclusions: We suggest that genetic and hormonal factors and interactions between hormones and gut microbiota could contribute to the sex differences observed in young children. These findings should provide clues about the mechanisms of the infection, and should be useful in targeting treatments and development of vaccines. Highlights: (1) This manuscript provides consistent estimates of the excess salmonellosis incidence rates in male children up to age 15, which suggests an impact of sex hormones or genetic differences. (2) Our findings should promote the further investigations on sex-related determinants of infectious diseases.

A Randomized mHealth Trial to Promote Vegetable Intake Through Counting and Goal Setting

OBJECTIVE

To determine if counting and goal setting can increase red/orange vegetable intake.

DESIGN

Pre-posttest experimental.

SETTING

Midwestern university.

PARTICIPANTS

Undergraduate students (n = 165).

INTERVENTION

Those in the intervention group (n = 85) were asked to count the number of times they ate red/orange vegetables and set a goal to eat 1 more time.

MAIN OUTCOME MEASURE

An estimate (number of times/d) of vegetable intake based on an independent review of uploaded photographs and descriptions of meals from smartphones.

ANALYSIS

Generalized estimating equations.

RESULTS

For the intervention group, mean frequency intake increased from 0.9 times/d on Monday to 1.6 times/d on Tuesday and to 1.3 times/d on Wednesday, whereas mean intakes for the control group were 1.0, 0.8, and 0.8 times/d, respectively. There were significant group × time interactions for Tuesday (β = 0.8; P < 0.001) and Wednesday (β = 0.5; P = 0.006).

CONCLUSIONS AND IMPLICATIONS

A mobile method that helped people count their daily red/orange vegetable intake and set a goal appeared to increase consumption. This finding suggests that nutrition education programs that provide people with easy ways to track specific dietary behaviors might be effective at helping them attain goals.

Sex disparities in dietary intake across the lifespan: the case of Lebanon

BACKGROUND

Little is known about sex-based dietary differences in middle-income countries, particularly those undergoing the nutrition transition. This study aims at examining sex disparities in energy and macronutrients' intakes, food consumption patterns, and micronutrients' adequacy in Lebanon, while adopting a life course approach.

METHODS

Data were derived from a national cross-sectional survey conducted in Lebanon in 2008/2009. The study sample consisted of 3636 subjects: 956 children and adolescents aged 6-19.9 years; 2239 adults aged 20-59.9 years and 441 older adults aged above 60 years. At the households, trained nutritionists conducted face-to-face interviews with participants to complete a sociodemographic questionnaire and one 24-h diet recall. Food items were categorized into 25 food groups. The Nutritionist Pro software was used for the analysis of dietary intake data and the estimation of energy, macronutrients', and micronutrients' intakes.

RESULTS

In all age groups, males had significantly higher energy intakes, while females had significantly higher fiber intakes. In addition, in adolescents aged 12-19.9 years, females had higher fat intakes as compared to males (37.02 ± 0.6% vs 35.03 ± 0.61%), and in adults aged 20-59.9 years, females had significantly higher total fat (37.73 ± 0.33% vs 36.45 ± 0.38%) and saturated fat intakes (11.24 ± 0.15% vs 10.45 ± 0.18%). These differences in macronutrient intakes were not observed in younger children nor in older adults. Sex-based differences in food groups' intakes were also observed: men and boys had significantly higher intakes of red and processed meat, bread, fast food, soft drinks, and alcohol, while girls and women had higher intakes of fruits, vegetables, milk, and sweets. In all age groups, females had lower micronutrient intakes compared to males, including calcium, iron, and zinc.

CONCLUSIONS

This study identified sex-specific priorities that ought to be tackled by context-specific interventions to promote healthier diets in Lebanon. The fact that sex-based differences in nutrient intakes and food consumption patterns were the most noticeable in the adolescent and adult years, hence women's reproductive years call for concerted efforts to improve nutrition for women and girls as this would lay the foundation not only for their future education, productivity, and economic empowerment, but also for the health of future generations.

Neighborhood Food Outlet Access and Dietary Intake among Adults with Chronic Kidney Disease: Results from the Chronic Renal Insufficiency Cohort Study

BACKGROUND

Healthy diet is essential in the management of chronic kidney disease (CKD) and preventing related comorbidities. Food outlet access has been studied in the general population; however, the influence of the local food environment on dietary intake among people with CKD has not been evaluated.

OBJECTIVES

This study examined the associations of food outlet density and type of outlets with dietary intake in a multicenter cohort of racially and ethnically diverse patients with CKD.

METHODS

The Chronic Renal Insufficiency Cohort Study is a multicenter prospective study of patients with CKD that used a validated food frequency questionnaire to capture dietary intake at the baseline visit. This is a cross-sectional analysis of 2,484 participants recruited in 2003-2006 from seven Chronic Renal Insufficiency Cohort Study centers. Food outlet data were used to construct a count of the number of fast-food restaurants, convenience stores, and grocery stores per 10,000 population for each geocoded census block group. Multivariable linear and logistic regression models were used to evaluate the associations between measures of food outlet availability and dietary factors.

RESULTS

The proportion of participants living in zero-, low-, and high-food outlet density areas differed by gender, race or ethnicity, and income level. Among male subjects, living in areas with zero or the highest number of outlets was associated with having the highest caloric intakes in multivariable models. Male subjects living in areas with zero outlets consumed the highest levels of sodium and phosphorous. Female subjects living in areas with zero outlets had the lowest average intake of calories, sodium, and phosphorous. Among low-income female subjects, close proximity to more outlets was associated with higher calorie consumption. Among all participants, access to fast-food restaurants was not associated with an unhealthy diet score, and access to grocery stores was not associated with a healthy diet score.

CONCLUSIONS

Average caloric and nutrient intakes differed by outlet availability; however, there were no strong associations with type of food outlet. This should be considered when developing food-focused public health policies.

The Association between Energy Balance-Related Behavior and Burn-Out in Adults: A Systematic Review

Although it is believed that physical activity, sedentary, and dietary behavior (i.e., energy balance-related behavior) may decrease the risk of burn-out, the association between both is currently not well understood. Therefore, the aim of this systematic review was to synthesize studies investigating the relationship between energy balance-related behavior and burn-out risk. A systematic literature search was conducted in four databases, resulting in 25 included studies (ten experimental and 15 observational studies). Nine out of ten experimental studies showed that exercise programs were effective in reducing burn-out risk. Fourteen out of fifteen observational studies found a negative association between physical activity and burn-out risk, whereas one study did not find a relation. Two of the 15 observational studies also showed that being more sedentary was associated with a higher burn-out risk, and two other studies found that a healthier diet was related to a lower burn-out risk. No experimental studies were found for the latter two behaviors. It can be concluded that physical activity may be effective in reducing burn-out risk. The few observational studies linking sedentary and dietary behavior with burn-out risk suggest that being more sedentary and eating less healthy are each associated with higher burn-out risk. More high-quality research is needed to unravel the causal relationship between these two behaviors and burn-out risk.

Gender inequalities in diet quality and their socioeconomic patterning in a nutrition transition context in the Middle East and North Africa: a cross-sectional study in Tunisia

Background

In a context of nutrition transition and major shifts in lifestyle and diet, the Middle East and North Africa features a marked gender excess adiposity gap detrimental to women. In this setting, where gender issues are especially acute, we investigated gender differences in dietary intake with a focus on diet quality, and how the differences varied with the area of residence and socio-demographic characteristics.

Methods

The study was conducted in 2009–2010 in the Greater Tunis region (Tunisia), as a case study of an advanced nutrition transition context in the region. A cross-sectional survey used a random, stratified, clustered sample of households: 1689 women and 930 men aged 20–49 years were analyzed. Dietary intake was assessed using a 3-day food record. Nutrient content was derived from a specific Tunisian food composition database. We analysed the Diet Quality Index-International (DQI-I) and sub-scores (variety, adequacy, moderation and balance). A score of DQI-I > 60 defined good diet quality. Inequality measures were women vs. men differences in means for interval variables and odds-ratios (OR) for DQI-I > 60. Their variation with socio-demographic characteristics was estimated using models featuring gender x covariate interactions.

Results

Mean energy intake/day was 2300 ± 15 kcal for women vs. 2859 ± 32 kcal for men. By 1000 g/kcal/d women consumed more fruits and sweets but less red meat and soft drinks than men. Women had a higher mean moderation sub-score than men (+ 1.8[1.4, 2.2], P < 0.0001) but lower variety (− 2.0[− 2.3, − 1.6], P < 0.0001) and adequacy (− 1.8[− 2.0, − 1.5], P < 0.0001). Thus, the overall mean DQI-I was lower among women than men (58.6 ± 0.3 vs. 60.4 ± 0.3, − 1.8[− 2.6, − 1.0], P < 0.0001) as was the proportion of DQI-I > 60 (45.2% vs. 55.7%, OR = 0.7[0.5, 0.8], P < 0.0001). Adjusted gender differences in DQI-I decreased with age but were higher in larger households and extreme categories of education (no-schooling and university) vs. the middle categories.

Conclusion

In this nutrition transition context with only average diet quality, it was somewhat lower for women. Socioeconomic patterning of gender contrasts was mild. Beyond, that women had lower adequacy and variety scores but better moderation is a possible pathway for gender specific prevention messages.

Electronic supplementary material

The online version of this article (10.1186/s12937-019-0442-6) contains supplementary material, which is available to authorized users.

Adequate and excessive food consumption in Suriname: a multiethnic middle-income country

OBJECTIVES

To explore food consumption among different sex, age, ethnic, urban, education and income groups in Suriname.

METHODS

Data from a cross-sectional population study (n = 5748; 15-64 year) were used. Food consumption was defined adequate if (1) fruit and vegetable intake was conformable to WHO recommendations, (2) mostly vegetable oil was used, and (3) whole-wheat products were used ≥ 3 days/week. Food consumption was defined excessive if 3 out of the following 5 items scored positive: consumption of (1) snack, (2) sweet, (3) fast food, or (4) soft drink ≥ 3 days/week, or (5) salt was always added while preparing a hot meal.

RESULTS

6.4% (95% CI 5.8-7.1) had an adequate and 21.9% (95% CI 20.9-23.0) an excessive food consumption pattern, with differences among ethnic groups (p < 0.05). Adequate consumption increased, while excessive consumption decreased with increasing age (p < 0.05). Both adequate and excessive consumption increased with higher degree of urbanization, level of education and income (p < 0.05). Except for level of education for adequate consumption, all characteristics remained in both models with adequate and excessive consumption as outcome (p < 0.09).

CONCLUSIONS

Our study suggests interventions to promote adequate food consumption in general and to limit excessive food consumption mainly focused on youngsters and those living in urbanized areas of higher socioeconomic status.

Weight resilience and fruit and vegetable intake among African-American women in an obesogenic environment

OBJECTIVE

To investigate relationships between weight resilience (maintaining a normal weight in a food desert environment) and fruit and vegetable (F&V) intake, attitudes and barriers.

DESIGN

Cross-sectional, in-person surveys collected May-December 2011, including self-reported data on F&V-related psychosocial factors, attitudes and barriers. Two 24 h dietary recalls were completed; weight and height were measured. Multivariable regression models estimated prevalence ratios (95 % CI).

SETTING

Two low-income, predominantly African-American food deserts in Pittsburgh, Pennsylvania, USA.

SUBJECTS

Women aged 18-49 years (n 279) who were the primary food shopper in a household randomly selected for a parent study.

RESULTS

Fifteen per cent were weight resilient, 30 % were overweight and 55 % were obese. Overall, 25 % reported eating ≥5 F&V servings/d. After adjustment for age, education, parity, employment, living alone, physical activity, per capita income and mean daily energy intake, women eating ≥5 F&V servings/d were 94 % more likely to be weight resilient compared with those eating <5 servings/d (1·94; 1·10, 3·43). Across BMI groups, self-efficacy regarding F&V consumption was high and few F&V barriers were reported. The most frequently reported barrier was concern about the cost of F&V (36 %). Of the attitudinal F&V-related factors, only concern about wasting food when serving F&V was associated with weight resilience in adjusted models (0·29; 0·09, 0·94). In a model predicting consuming ≥5 F&V servings/d, driving one's own car to the store was the only attitudinal F&V-related factor associated with consumption (1·50; 1·00, 2·24).

CONCLUSIONS

In this population, weight resilience may be encouraged by improving access to affordable and convenient F&V options and providing education on ways to make them palatable to the entire household, rather than by shifting women's F&V perceptions, which are already positive.

Cardiometabolic Disease Staging Predicts Effectiveness of Weight-Loss Therapy to Prevent Type 2 Diabetes: Pooled Results From Phase III Clinical Trials Assessing Phentermine/Topiramate Extended Release

OBJECTIVE

To assess the ability of medication-assisted weight loss to prevent diabetes as a function of the baseline weighted Cardiometabolic Disease Staging (CMDS) score.

RESEARCH DESIGN AND METHODS

We pooled data from 3,040 overweight and obese participants in three randomized controlled trials-CONQUER, EQUIP, and SEQUEL-assessing efficacy and safety of phentermine/topiramate extended release (ER) for weight loss. In these double-blind phase III trials, overweight/obese adult patients were treated with a lifestyle intervention and randomly assigned to placebo versus once-daily oral phentermine/topiramate ER. The weighted CMDS score was calculated using baseline quantitative clinical data including waist circumference, blood glucose, blood pressure, and blood lipids. Incident diabetes was defined based on serial measures of fasting glucose, 2-h oral glucose tolerance test glucose, and/or HbA_1c.

RESULTS

The absolute decrease in 1-year diabetes incidence rates in subjects treated with medication versus placebo was greatest in those with high-risk CMDS scores at baseline (10.43-6.29%), intermediate in those with moderate CMDS risk (4.67-2.37%), and small in the low-risk category (1.51-0.67%). The number of participants needed to treat to prevent one new case of diabetes over a 56-week period was 24, 43, and 120 in those with baseline CMDS scores of ≥60, 30-59, and 0-29, respectively.

CONCLUSIONS

Numbers needed to treat to prevent one case of type 2 diabetes are markedly lower in patients with high-risk scores. CMDS can be used to quantify risk of diabetes in overweight/obese individuals and predict the effectiveness of weight-loss therapy to prevent diabetes.

The Local Food Environment and Fruit and Vegetable Intake: A Geographically Weighted Regression Approach in the ORiEL Study

Studies that explore associations between the local food environment and diet routinely use global regression models, which assume that relationships are invariant across space, yet such stationarity assumptions have been little tested. We used global and geographically weighted regression models to explore associations between the residential food environment and fruit and vegetable intake. Analyses were performed in 4 boroughs of London, United Kingdom, using data collected between April 2012 and July 2012 from 969 adults in the Olympic Regeneration in East London Study. Exposures were assessed both as absolute densities of healthy and unhealthy outlets, taken separately, and as a relative measure (proportion of total outlets classified as healthy). Overall, local models performed better than global models (lower Akaike information criterion). Locally estimated coefficients varied across space, regardless of the type of exposure measure, although changes of sign were observed only when absolute measures were used. Despite findings from global models showing significant associations between the relative measure and fruit and vegetable intake (β = 0.022; P < 0.01) only, geographically weighted regression models using absolute measures outperformed models using relative measures. This study suggests that greater attention should be given to nonstationary relationships between the food environment and diet. It further challenges the idea that a single measure of exposure, whether relative or absolute, can reflect the many ways the food environment may shape health behaviors.

Trends in Cardiovascular Health Metrics in Obese Adults: National Health and Nutrition Examination Survey (NHANES), 1988-2014

BACKGROUND

No study has quantified trends in the prevalence of cardiovascular disease risk factors and cardiovascular health metrics among obese people in the United States in recent years.

METHODS AND RESULTS

We examined the secular changes in cardiovascular health metrics and key cardiovascular disease risk factors among obese adults (aged ≥20 years) in the United States. We included 18 626 obese adults (body mass index ≥30) from the National Health and Nutrition Examination Survey (NHANES) III and NHANES 1999-2014. Among those obese adults, there were decreases in mean systolic blood pressure, diastolic blood pressure, and total cholesterol levels and increases in mean high-density lipoprotein cholesterol levels and mean hemoglobin A1c levels. Prevalence of blood pressure health and lipid health remained stable during the period 1988-2014, whereas prevalence of blood glucose health decreased significantly during this period. Prevalence of freedom from cardiovascular disease risk factors remained stable at ≈15% among the adult obese population during the period 1988-2014, whereas prevalence of presence of all 3 risk factors increased from 16.4% to 22.4% during this period, commensurate with a decline in those with 1 to 2 risk factors (from 69.6% to 62.4%).

CONCLUSIONS

During the past 3 decades, blood pressure health and blood lipid health remained stable or improved, whereas blood glucose health deteriorated among adult obese population. This resulted in an overall decrease in cardiovascular health status among obese adults and greater risk of type 2 diabetes mellitus. The data argue for interventions targeted to those obese persons who are metabolically unhealthy to stem rising rates of diabetes mellitus.

Differences in Perceptions of the Food Environment Between African American Men Who Did and Did Not Consume Recommended Levels of Fruits and Vegetables

African American men have high rates of chronic disease morbidity and mortality associated with their low rates of fruit and vegetable consumption. In an effort to inform tailored behavioral interventions for this demographic, we sought to assess if men with healthier eating practices viewed their environment differently than those who ate less healthy. We segmented participants into high/low healthy eating categories based on the daily fruit and vegetable serving recommendations from the U.S. Department of Agriculture to determine if differences among environmental and social barriers were associated with different healthy eating patterns. We found key differences between men who consumed the recommended amount of fruits and vegetables (five or more servings/day, high healthy eating) and men who did not (low healthy eating). Men who consumed recommended levels of fruits and vegetables found eating healthy to be easy, and they described how they were able to overcome barriers such as the cost of healthy food, their limited knowledge of nutrition guidelines, and their lack of willpower to make healthier food choices. Men with healthier eating practices also identified individuals, plans, and resources they used or could use to help them have healthier eating practices. Conversely, men who were not eating recommended levels of fruits and vegetables also found eating healthy to be easy; however, they identified barriers limiting their access and did not articulate strategies to overcome these perceived barriers. Many of these men also indicated that they did not have social support to help them engage in healthier eating practices. These findings highlight the need to understand how African American men’s conceptualization of environmental resources and social supports relate to their eating practices.

Salmonella enterica Infections in the United States and Assessment of Coefficients of Variation: A Novel Approach to Identify Epidemiologic Characteristics of Individual Serotypes, 1996-2011

Background

Despite control efforts, salmonellosis continues to cause an estimated 1.2 million infections in the United States (US) annually. We describe the incidence of salmonellosis in the US and introduce a novel approach to examine the epidemiologic similarities and differences of individual serotypes.

Methods

Cases of salmonellosis in humans reported to the laboratory-based National Salmonella Surveillance System during 1996–2011 from US states were included. Coefficients of variation were used to describe distribution of incidence rates of common Salmonella serotypes by geographic region, age group and sex of patient, and month of sample isolation.

Results

During 1996–2011, more than 600,000 Salmonella isolates from humans were reported, with an average annual incidence of 13.1 cases/100,000 persons. The annual reported rate of Salmonella infections did not decrease during the study period. The top five most commonly reported serotypes, Typhimurium, Enteritidis, Newport, Heidelberg, and Javiana, accounted for 62% of fully serotyped isolates. Coefficients of variation showed the most geographically concentrated serotypes were often clustered in Gulf Coast states and were also more frequently found to be increasing in incidence. Serotypes clustered in particular months, age groups, and sex were also identified and described.

Conclusions

Although overall incidence rates of Salmonella did not change over time, trends and epidemiological factors differed remarkably by serotype. A better understanding of Salmonella, facilitated by this comprehensive description of overall trends and unique characteristics of individual serotypes, will assist in responding to this disease and in planning and implementing prevention activities.

The Utility of the Memorable Messages Framework as an Intermediary Evaluation Tool for Fruit and Vegetable Consumption in a Nutrition Education Program

Additional strategies to evaluate the impact of community nutrition education programs on low-income individuals are needed. The objective of this qualitative study was to examine the use of the Memorable Messages Framework as an intermediary nutrition education program evaluation tool to determine what fruit and vegetable messages were reported as memorable and the characteristics of those memorable messages. A convenience sample of low-income, primarily African American adults (N = 58) who previously completed a series of community nutrition education lessons within an urban area of Indiana participated in a focus group (N = 8 focus groups). A lead moderator using a semistructured script conducted the focus groups to determine what information about fruits and vegetables was most memorable from the participants' nutrition lessons and why this information was memorable. All focus group audiotapes were transcribed verbatim and ATLAS.ti software was used to code and identify themes within the data. Participants cited quantity, variety, and the positive nutritional impact of eating fruits and vegetables as most memorable. Information given in the form of recipes was also cited as most memorable. For example, participants referred to the recipe demonstrations as not only fun but also key components of the program that helped with message retention and memorability. Key characteristics of memorable messages included personal relevance and message vividness. These findings indicated that the Memorable Messages Framework may serve as an intermediary program evaluation tool to identify what information and messages are most influential to participants in community nutrition education programs.

Evaluation of the Relative Validity of the Short Diet Questionnaire for Assessing Usual Consumption Frequencies of Selected Nutrients and Foods

A 36-item Short Diet Questionnaire (SDQ) was developed to assess usual consumption frequencies of foods providing fats, fibre, calcium, vitamin D, in addition to fruits and vegetables. It was pretested among 30 community-dwelling participants from the Québec Longitudinal Study on Nutrition and Successful Aging, “NuAge” (n = 1793, 52.4% women), recruited in three age groups (70 ± 2 years; 75 ± 2 years; 80 ± 2 years). Following revision, the SDQ was administered to 527 NuAge participants (55% female), distributed among the three age groups, both sexes and languages (French, English) prior to the second of three non-consecutive 24 h diet recalls (24HR) and validated relative to the mean of three 24HR. Full data were available for 396 participants. Most SDQ nutrients and fruit and vegetable servings were lower than 24HR estimates (p < 0.05) except calcium, vitamin D, and saturated and trans fats. Spearman correlations between the SDQ and 24HR were modest and significant (p < 0.01), ranging from 0.19 (cholesterol) to 0.45 (fruits and vegetables). Cross-classification into quartiles showed 33% of items were jointly classified into identical quartiles of the distribution, 73% into identical and contiguous quartiles, and only 7% were frankly misclassified. The SDQ is a reasonably accurate, rapid approach for ranking usual frequencies of selected nutrients and foods. Further testing is needed in a broader age range.

Inter- and independent effects of region and race/ethnicity on variety of fruit and vegetable consumption in the USA: 2011 Behavioral Risk Factor Surveillance System (BRFSS)

OBJECTIVE

(i) To estimate the independent and combined effects of race/ethnicity and region on the variety of fruits and vegetables consumed in the USA in 2011; and (ii) to assess whether and to what extent race/ethnicity and region may synergistically influence variety of fruit and vegetable consumption.

DESIGN

Cross-sectional analysis. Multivariate logistic regression predicted the likelihood of meeting fruit and vegetable variety indicators independently and in combination for each race/ethnicity and region. Interaction effects models were used to test for interaction effects between race/ethnicity and region on fruit and vegetable variety.

SETTING

The 2011 Behavioral Risk Factor Surveillance System (BRFSS).

SUBJECTS

The sample consisted of 275 864 adult respondents.

RESULTS

Fewer than half of respondents consumed fruit and all vegetable subcategories at least once weekly. The adjusted likelihood of meeting fruit and vegetable variety indicators varied significantly by race/ethnicity and region (P<0·05). Significant interactions between race/ethnicity and region were found for at least once weekly consumption of beans, orange vegetables, all vegetables, and fruit and all vegetables (P<0·05).

CONCLUSIONS

Our results reinforce previous findings that the variety of vegetable consumption is lacking and is particularly evident among some population subgroups, such as non-Hispanic blacks in the Midwest USA, who may benefit from targeted dietary interventions.

Factors associated with the feeding practices of the adult population of Goiânia, Goiás, Brazil

This cross-sectional study identified the factors associated with adult feeding practices in Goiânia, the capital of the state of Goiás, in the Midwestern region of Brazil, by means of telephone interviews with 2,002 adults (> 18 years old). Information about demographic aspects, lifestyle, nutritional status, and food consumption was collected, leading to a sum of healthy food choices. It was observed that men and women have an average of two healthy food choices and low frequency of fruit intake (5.4% of men; 8.5% of women), as well as the consumption of legumes and vegetables (18.1% of men; 22.6% of women). The hierarchical multiple regression analysis revealed that the mean healthy food choice among men increases with age and physical practice, and among women, with paid work. The prevalence of unhealthy food choices associated with other risk behaviors favors the development of chronic diseases. Multi-strategy and intersectorial actions are necessary to overcome this situation.

Association between folate intake and the risk of lung cancer: a dose-response meta-analysis of prospective studies

Background

Studies have reported inconsistent results regarding the existence of an association between folate intake and the risk of lung cancer. The purpose of this study was to summarize the evidence from prospective cohort studies regarding this relationship by using a dose-response meta-analytic approach.

Methodology and Principal Findings

In September 2013, we performed electronic searches in PubMed, Embase, and the Cochrane Library to identify studies examining the effect of folate intake on the incidence of lung cancer. Only prospective cohort studies that reported the effect estimates about the incidence of lung cancer with 95% confidence intervals (CIs) for more than 2 categories of folate intake were included. Overall, we examined 9 cohort studies reporting the data of 566,921 individuals. High folate intake had little effect on the risk of lung cancer (risk ratio [RR], 0.92; 95% CI, 0.84–1.01; P = 0.076). Dose-response meta-analysis also suggested that a 100 µg/day increase in folate intake had no significant effect on the risk of lung cancer (RR, 0.99; 95% CI, 0.97–1.01; P = 0.318). Subgroup analysis suggested that the potential protective effect of low folate intake (100–299 µg/day) was more evident in women than men, while the opposite was true of high folate intake (>400 µg/day). Finally, subgroup analyses of a 100 µg/day increment in folate intake indicated that its potential protective effect was more evident in men than in women.

Conclusion/Significance

Our study revealed that folate intake had little or no effect on the risk of lung cancer. Subgroup analyses indicated that an increased folate intake was associated with a reduced risk of lung cancer in men. Furthermore, low folate intake may be a protective factor for women, and high folate intake for men.

Obesogenic environmental influences on young adults: evidence from college dormitory assignments

This study utilizes a natural experiment-conditionally random dormitory assignments of first-year US college students-to investigate the influence of obesogenic environmental factors in explaining changes in weight and exercise behavior during the 2009-2010 academic year. The design addresses potential selection biases resulting from the likelihood that individuals sort into built environments that match their preferences for exercise and healthy eating. We find some evidence that the food environment, specifically access to campus dining, significantly affected the weight of female students in our study. Females assigned to dormitories where the nearest campus dining hall was closed on the weekends gained about 1lb less over the course of the year than females assigned to dormitories near dining halls that were open 7 days a week. We also find some evidence that female who lived in close proximity to a grocery store gained less weight over the course of the year. Finally, females who lived closer to campus gym reported more frequent exercise over the course of the year. We do not find significant effects of the built environment on weight changes of males in our sample, but we are cautious to draw strong conclusions from this because the male weight change in our sample was quite small.

Automated interventions for multiple health behaviors using conversational agents

OBJECTIVE

An automated health counselor agent was designed to promote both physical activity and fruit and vegetable consumption through a series of simulated conversations with users on their home computers.

METHODS

The agent was evaluated in a 4-arm randomized trial of a two-month daily contact intervention comparing: (a) physical activity; (b) fruit and vegetable consumption; (c) both interventions; and (d) a non-intervention control. Physical activity was assessed using daily pedometer steps. Daily servings of fruit and vegetables were assessed using the NIH/NCI self-report Fruit and Vegetable Scan.

RESULTS

Participants in the physical activity intervention increased their walking on average compared to the control group, while those in the fruit and vegetable intervention and combined intervention decreased walking. Participants in the fruit and vegetable intervention group consumed significantly more servings per day compared to those in the control group, and those in the combined intervention reported consuming more compared to those in the control group.

CONCLUSION

Automated health intervention software designed for efficient re-use is effective at changing health behavior.

PRACTICE IMPLICATIONS

Automated health behavior change interventions can be designed to facilitate translation and adaptation across multiple behaviors.

Use of farmers markets by mothers of WIC recipients, Miami-Dade County, Florida, 2011

Introduction

Farmers market-based interventions, including the Farmers’ Market Nutrition Program of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), represent a promising strategy for improving dietary behaviors in low-income communities. Little is known, however, about the health-related characteristics of low-income parents who frequent farmers markets in urban settings. The objective of this study was to examine the relationship between family-health factors and the use of farmers markets by mothers of WIC recipients.

Methods

We recruited a convenience sample of mothers of children seeking care at a primary care clinic in a large urban public hospital in Miami, Florida, in 2011 (n = 181 total). The clinic was adjacent to a newly established farmers market at the hospital. Each mother completed an interviewer-administered survey that included self-reported measures of maternal and child health, acculturation, dietary behaviors, food insecurity, and use of farmers markets.

Results

Reported use of farmers markets was independently associated with maternal history of diabetes (odds ratio [OR], 6.9; 95% confidence interval [CI], 1.3–38.3) and increased maternal vegetable (but not fruit) consumption (OR, 3.5; 95% CI, 1.5–8.1). Intended future use of farmers markets was independently associated with being unemployed (OR, 2.4; 95% CI, 1.0–5.7), increased maternal vegetable consumption (OR, 2.5; 95% CI, 1.1–5.7), and food insecurity (OR, 3.6; 95% CI, 1.3–10.3).

Conclusions

This study provides a snapshot of factors associated with farmers market use in a diverse population of urban low-income families. Understanding these factors may inform public health approaches to increase fresh fruit and vegetable consumption in communities at high risk for preventable chronic conditions.

Fruit and vegetable intake among older adults: a scoping review

Older adults are the fastest growing segment of the world population. Older adults are also at heightened risk of chronic conditions (such as diabetes, heart disease, and cancer) and specific geriatric conditions (such as cognitive impairment, frailty, and falls). Research studies have examined the relationship between fruit and vegetable intake and subsequent health outcomes and the correlates of fruit and vegetable intake in the U.S. population. However, relatively few studies have specifically examined health impacts and correlates of fruit and vegetable intake among older adults, who have unique biophysical and socioeconomic circumstances. Evidence is reviewed to (1) describe findings related to consumption and chronic, geriatric, and other health outcomes among older adults and (2) describe patterns in fruit and vegetable consumption among older adults and how these patterns vary within and among populations. This review addresses specific barriers faced by older adults in obtaining and consuming fruits and vegetables in community settings. Recommendations for practice and policy are discussed.

Are Child Eating Patterns Being Transformed Globally?

OBJECTIVE

To examine the extent to which child dietary patterns and trends are changing globally.

RESEARCH METHODS AND PROCEDURES

Diets of children 2 to 19 years of age were studied with nationally representative data from Russia and the United States, nationwide data from China, and regional data from metropolitan Cebu, Philippines. Twenty-four-hour dietary recalls were examined at several points in time to examine trends in calories consumed away from home, snacking behavior, and soft drink and modern fast food consumption. Urban-rural trends were compared.

RESULTS

U.S. and Cebu youth consume more than one-third of their daily calories and a higher proportion of snack calories from foods prepared away from home. In contrast, away from home food consumption is minimal in Chinese and Russian children. U.S. and Cebu youth consume about one-fifth of their total daily energy from snacks, but snacks provide a much lower proportion of energy in Russia ( approximately 16%) and China (where snacks provide only approximately 1% of energy). Fast food plays a much more dominant role in the American diet ( approximately 20% of energy vs. 2% to 7% in the other countries), but as yet does not contribute substantially to children's diets in the other countries. Urban-rural differences were found to be important, but narrowing over time, for China and Cebu, whereas they are widening for Russia.

DISCUSSION

This research suggests that globalization of the fast food and other modern food sectors is beginning to affect child eating patterns in several countries undergoing nutrition transition. However, the contribution of fast food and soft drinks to the diet of children remains relatively small in China, Russia, and Cebu, Philippines, relative to the United States.

Insect pollinated crops, insect pollinators and US agriculture: trend analysis of aggregate data for the period 1992-2009

In the US, the cultivated area (hectares) and production (tonnes) of crops that require or benefit from insect pollination (directly dependent crops: apples, almonds, blueberries, cucurbits, etc.) increased from 1992, the first year in this study, through 1999 and continued near those levels through 2009; aggregate yield (tonnes/hectare) remained unchanged. The value of directly dependent crops attributed to all insect pollination (2009 USD) decreased from $14.29 billion in 1996, the first year for value data in this study, to $10.69 billion in 2001, but increased thereafter, reaching $15.12 billion by 2009. The values attributed to honey bees and non-Apis pollinators followed similar patterns, reaching $11.68 billion and $3.44 billion, respectively, by 2009. The cultivated area of crops grown from seeds resulting from insect pollination (indirectly dependent crops: legume hays, carrots, onions, etc.) was stable from 1992 through 1999, but has since declined. Production of those crops also declined, albeit not as rapidly as the decline in cultivated area; this asymmetry was due to increases in aggregate yield. The value of indirectly dependent crops attributed to insect pollination declined from $15.45 billion in 1996 to $12.00 billion in 2004, but has since trended upward. The value of indirectly dependent crops attributed to honey bees and non-Apis pollinators, exclusive of alfalfa leafcutter bees, has declined since 1996 to $5.39 billion and $1.15 billion, respectively in 2009. The value of alfalfa hay attributed to alfalfa leafcutter bees ranged between $4.99 and $7.04 billion. Trend analysis demonstrates that US producers have a continued and significant need for insect pollinators and that a diminution in managed or wild pollinator populations could seriously threaten the continued production of insect pollinated crops and crops grown from seeds resulting from insect pollination.

Date fruits (Phoenix dactylifera Linn): an emerging medicinal food

Date palm is one of the oldest trees cultivated by man. In the folk-lore, date fruits have been ascribed to have many medicinal properties when consumed either alone or in combination with other herbs. Although, fruit of the date palm served as the staple food for millions of people around the world for several centuries, studies on the health benefits are inadequate and hardly recognized as a healthy food by the health professionals and the public. In recent years, an explosion of interest in the numerous health benefits of dates had led to many in vitro and animal studies as well as the identification and quantification of various classes of phytochemicals. On the basis of available documentation in the literature on the nutritional and phytochemical composition, it is apparent that the date fruits are highly nutritious and may have several potential health benefits. Although dates are sugar-packed, many date varieties are low GI diet and refutes the dogma that dates are similar to candies and regular consumption would develop chronic diseases. More investigations in these areas would validate its beneficial effects, mechanisms of actions, and fully appreciate as a potential medicinal food for humans all around the world. Therefore, in this review we summarize the phytochemical composition, nutritional significance, and potential health benefits of date fruit consumption and discuss its great potential as a medicinal food for a number of diseases inflicting human beings.

Who consumed 5 or more portions of fruit and vegetables per day in 1986-1987 and in 2000-2001?

OBJECTIVE

The aim of the study was to describe who ate 5 or more portions of fruit and vegetables per day ('compliers') in 1986-1987 and in 2000-2001.

DESIGN

We used data from the Dietary and Nutritional Surveys of British Adults. Each is a nationally representative dietary survey using 7 d weighed food records for men and women, aged 16-64 years, living in private households in Great Britain in 1986-1987 and in 2000-2001.

SETTING

Great Britain.

SUBJECTS

Data were analysed for 2197 adults in 1986-1987 and 1724 adults in 2000-2001.

RESULTS

In 1986-1987 12·7 % were classified as 'compliers' compared with 16·5 % in 2000-2001. Manual social classes, younger participants and people on benefits or outside paid employment were less likely to be 'compliers'. Being divorced, widowed or separated was negatively related to being a 'complier', as was being in a household with dependant children or a lone parent with dependant children. Between 1986-1987 and 2000-2001 improvements were seen across social class groups and differences between men and women and between regions were reduced.

CONCLUSIONS

Only 12·7 % participants in the Dietary and Nutritional Surveys of British Adults were classified as 'compliers' in 1986-1987 compared with 16·5 % in 2000-2001. There have been some important changes in the distribution of 'compliers', but the low levels overall support the need for a reinvigorated policy drive to improve compliance with fruit and vegetable goals.

Divergent trends for gastric cancer incidence by anatomical subsite in US adults

BACKGROUND AND AIM

Age-specific analyses of non-cardia gastric cancer incidence reveal divergent trends among US whites: rates are declining in individuals aged 40 years and older but rising in younger persons. To investigate this heterogeneity further, incidence trends were evaluated by anatomical subsite.

METHODS

Gastric cancer incidence data for 1976-2007 were obtained from the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program and the US Centers for Disease Control and Prevention's National Program of Cancer Registries (NPCR). Incidence rates and estimated annual percentage change were calculated by age group (25-39, 40-59 and 60-84 years), race/ethnicity and subsite.

RESULTS

Based on data from the nine oldest SEER registries (covering ~10% of the US population), rates for all non-cardia subsites decreased in whites and blacks, except for corpus cancer, which increased between 1976 and 2007 with estimated annual percentage changes of 1.0% (95% CI 0.1% to 1.9%) for whites and 3.5% (95% CI 1.8% to 5.2%) for blacks. In contrast, rates for all non-cardia subsites including corpus cancer declined among other races. In combined data from NPCR and SEER registries (covering 89% of the US population), corpus cancer significantly increased between 1999 and 2007 among younger and middle-aged whites; in ethnic-specific analyses, rates significantly increased among the same age groups in non-Hispanic whites and were stable among Hispanic whites. Age-specific rates for all subsites declined or were stable in this period among blacks and other races.

CONCLUSIONS

Long- and short-term incidence trends for gastric cancers indicate a shifting distribution by anatomical subsite. Corpus cancer may have distinctive aetiology and changing risk factor exposures, warranting further investigation.

A randomized experiment to examine unintended consequences of dietary supplement use among daily smokers: taking supplements reduces self-regulation of smoking

AIMS

We examined whether smokers' use of dietary supplements (e.g. vitamin C, multi-vitamins) induces illusory invulnerability that in turn disinhibits smoking. Such supplement use may be perceived as conferring health credentials.

DESIGN

  A single-factor (credentials: with or without) between-subjects design was employed. Smokers were assigned randomly to take either a known placebo pill or a dietary supplement (in fact, the same placebo) in an ostensible health-food test.

SETTING

  Laboratory at Kaohsiung Medical University, Taiwan.

PARTICIPANTS

  Study 1 involved of a student sample consisting of 74 daily smokers, whereas study 2 involved a community sample consisting of 80 daily smokers.

MEASUREMENTS

  In Study 1, participants reported their perceived invulnerability following the manipulation. In study 2, pre- and post-test measures of invulnerability were administered, and attitudes towards dietary supplements were assessed prior to the manipulation. In both studies, the dependent measure was the number of cigarettes smoked during completion of an unrelated survey.

FINDINGS

  Participants who believed that they were taking a dietary supplement smoked more cigarettes than did controls. Study 1 found support for the role of perceived invulnerability as a mechanism underlying this effect. Study 2 demonstrated the moderating effect played by attitudes towards dietary supplements: a more positive attitude towards supplements increased susceptibility to licensing effects.

CONCLUSIONS

  Dietary supplement use may create illusory invulnerability, reducing the self-regulation of smoking. Reminding health-conscious smokers that multi-vitamins do not prevent cancer may help such smokers to control their smoking and encourage them to stop.

Increasing access and affordability of produce improves perceived consumption of vegetables in low-income seniors

High cost and limited access to food have been associated with lower intake of fruits and vegetables in limited-income individuals. The Veggie Mobile is a van that carries fresh produce and travels in low-income neighborhoods, selling fruits and vegetables at a fraction of regular supermarket prices. The purpose of this study was to determine whether participation in the Veggie Mobile increases fruit and vegetable intake in a group of seniors. The intervention, buying fruits and vegetables from the Veggie Mobile, was implemented between April and October 2008 in two senior housing sites that had not previously received Veggie Mobile services. Participants were asked about fruit and vegetable intake using a modified six-item questionnaire based on the Behavioral Risk Factor Surveillance System at preintervention and again at 3 to 5 months. The post-survey also included questions about perceived benefits and barriers to using the Veggie Mobile. The two cross-sections of seniors were matched using date of birth. Wilcoxon signed rank test and paired samples t tests examined change in pre- and post-intervention variables. Seventy-nine older adults completed the baseline survey and 63 completed the post-survey. Of these, 43 participants completed both surveys (70% white [n=30], mean age 69 ± 9 years). Mean intake of fruits and vegetables after using the Veggie Mobile increased by 0.37 servings/day. Vegetable intake alone increased from 1.98 ± 1.71 servings/day to 2.58 ± 1.4 servings/day (P=0.027), half of which was potatoes. Change in fruit intake was not significant (P=0.358). At post-intervention, seniors visited the supermarket less often (P=0.001) and spent an average of $14.92 less during their last visit. The majority of participants who completed the post-survey (62 of 63) indicated being satisfied with the program. The Veggie Mobile provides an example of a simple community intervention that has potential to lead to positive behavior change among low-income seniors.

Allocation of household responsibilities influences change in dietary behavior

This study was undertaken to understand dietary behavior as situated within the household, an important social context that serves to either inhibit or promote a healthy diet. Data were collected as part of a worksite-based health behavior intervention trial that took place between 1999 and 2003 in small manufacturing businesses in New England, U.S.A. The subjects were a cohort of 790 male and female workers who participated in the intervention trial and responded to both the baseline and the 18-month follow-up surveys. Regression models were built to determine whether proportion of household responsibility predicted daily fruit and vegetable consumption and weekly red meat consumption at 18-months. The results indicate that participants who were responsible for earning most or all of the money to support the household ate more servings of fruits and vegetables per day at 18-month follow-up than those without this responsibility. Further, those responsible for earning about half ate fewer servings of red meat than those responsible for earning most or all of the money to support the household. The results for red meat consumption differed by sex, such that responsibility for more than half or less than half of the money to support the household had different effects for men and women. The results of this study demonstrate that the distribution of household responsibilities can be an important factor in determining the effectiveness of a worksite-based health behavior intervention and that these effects can be different for women versus men.

Avaliação dos marcadores de consumo alimentar do VIGITEL (2007-2009)

OBJETIVO: Avaliar as questões marcadoras de consumo alimentar do Sistema Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico e sua evolução temporal. MÉTODOS: Foram avaliados 135.249 indivíduos de 27 cidades brasileiras, entrevistados nos anos de 2007 - 2009. Os marcadores de consumo alimentar foram descritos a partir da frequência de consumo de frutas, hortaliças, feijão, leite integral e desnatado, refrigerante normal e diet/light, e consumo de gordura aparente das carnes e a pele do frango. Avaliou-se a evolução temporal desses marcadores e, adicionalmente, testou-se a elaboração de um escore de alimentação saudável e a identificação de padrões alimentares por meio da análise de cluster. RESULTADOS: Observou-se aumento estatisticamente significativo nas frequências de consumo de feijão, leite integral e refrigerante normal e diminuição no consumo de leite desnatado. Mesmo com aumento de 11 para 13% de indivíduos que referiram consumir feijão diariamente, esses percentuais são baixos; assim como o consumo recomendado de 3 porções de frutas e 3 porções de hortaliças por dia, que foi referido por menos de 15% da população em todos os anos, com queda de 5 para 3% para as hortaliças. O refrigerante não diet foi o item com maior aumento no consumo, passando de 60 para 67%. Os itens avaliados apresentaram fraca correlação e não configuram um constructo único de alimentação saudável. CONCLUSÃO: A qualidade da dieta dos brasileiros tem piorado e é necessária melhor qualificação dos marcadores alimentares considerados de risco para doenças crônicas não-transmissíveis.

Increasing vegetable intake in Mexican-American youth: a randomized controlled trial

Despite the health benefits, vegetable intake in youth remains below recommended levels. The purpose of our study was to compare two methods for increasing vegetable consumption. It was hypothesized that participants randomized to both the exposure-only and the pairing condition would increase their vegetable consumption and increase the variety of vegetables consumed. A total of 78 Mexican-American middle school-aged children from a charter school in Houston, TX, were randomized to a pairing condition (n=40) or an exposure-only condition (n=38) during the Spring 2009 semester. Children in the pairing condition were provided a preferred taste (peanut butter) paired with vegetables weekly at school during a nutrition class for 4 months. Children in the exposure-only condition received vegetables weekly during a nutrition class that covered the same material as the pairing condition. After 4 months, the pairing condition participants demonstrated significant increases in vegetable consumption (F=13.40, P<0.001) as well as variety of vegetables eaten (F=13.69, P<0.001) when compared to those in the exposure-only condition. The findings of this study suggest that the pairing of vegetables with a preferred taste, such as peanut butter, may be an effective technique in increasing consumption, especially in children who report being resistant to eating vegetables.

Peer effects and the freshman 15: evidence from a natural experiment

This study investigates the importance of peer effects in explaining weight gain among freshman college students. We exploit a natural experiment that takes place on most college campuses in the US--randomized roommate assignments. While previous studies suggest that having an obese spouse, friend, or sibling increases one's likelihood of becoming obese, these social interactions are clearly non-random. We collect data from female students living on campus at a private Midwestern university at the beginning and end of their first year of college. Our findings suggest that the amount of weight gained during the freshman year is strongly and negatively correlated to the roommate's initial weight. Further, our analysis of behaviors suggests that female students adopt some of their roommates' weight-loss behaviors which cause them to gain less weight than they otherwise would have. In particular, we find evidence that this effect may be through influences in eating, exercise, and use of weight loss supplements.

A reusable framework for health counseling dialogue systems based on a behavioral medicine ontology

Automated approaches to promoting health behavior change, such as exercise, diet, and medication adherence promotion, have the potential for significant positive impact on society. We describe a theory-driven computational model of dialogue that simulates a human health counselor who is helping his or her clients to change via a series of conversations over time. Applications built using this model can be used to change the health behavior of patients and consumers at low cost over a wide range of media including the web and the phone. The model is implemented using an OWL ontology of health behavior change concepts and a public standard task modeling language (ANSI/CEA-2018). We demonstrate the power of modeling dialogue using an ontology and task model by showing how an exercise promotion system developed in the framework was re-purposed for diet promotion with 98% reuse of the abstract models. Evaluations of these two systems are presented, demonstrating high levels of fidelity to best practices in health behavior change counseling.

Diet and prostate cancer risk with specific focus on dairy products and dietary calcium: a case-control study

BACKGROUND

Despite the prevalence of prostate cancer worldwide, only a few risk factors have been well-established. The role of diet, especially of dairy products, in the etiology of prostate cancer is still controversial.

METHODS

This study assessed the association of dietary components, particularly dairy products and dietary calcium, on prostate cancer risk in a case-control study of 197 cases and an equal number of individually matched controls recruited in Montreal, Canada. A semi-quantitative food frequency questionnaire was administered in which the usual consumption frequency and amounts consumed of more than 200 food items were recorded.

RESULTS

We found a twofold increased risk of prostate cancer associated with an increased intake of dairy products {Odds Ratio (OR) = 2.19; 95% Confidence Intervals (CI) 1.22-3.94}. A significant trend of decreasing prostate cancer risk with higher intake was found for legumes, nuts, finfish/shellfish and for alpha-tocopherol after adjustment for calcium intake. Milk was the only dairy product significantly associated with prostate cancer risk, with OR = 2.27; 95% CI (1.25-4.09) for the highest versus lowest quartiles of consumption. Calcium, the main micronutrient contained in dairy products, showed only a borderline association with prostate cancer risk (P = 0.09), with slightly higher risk for higher calcium intake. In conclusion, this study supports the hypothesis that dairy products, especially milk, are involved in the etiology of prostate cancer. However, the mechanisms by which the various nutrients in dairy products and total diet may interact to influence this risk remain unknown.

Investigating fruit and vegetable consumption using the transtheoretical model

PURPOSE

Test the applicability of the transtheoretical model (TTM) to adult fruit/vegetable consumption.

DESIGN

Cross-sectional random-digit dial survey.

SETTING

Hawaii.

SUBJECTS

700 (62.6% female; age [mean +/- SD], 47 +/- 17.1 years; education [mean +/- SD], 14.6 +/- 2.8 years; 35.0% white, 31.1% Asian, 22.1% native Hawaiian/Pacific Islander, 11.8% other).

MEASURES

Stages, processes, self-efficacy, decisional balance, and self-reported fruit/vegetable consumption.

ANALYSIS

Confirmatory factor analysis tested the factor structure. Analyses of variance were used to explore stage differences in constructs.

RESULTS

Stage distribution was precontemplation (33%), contemplation (4%), preparation (37%), action (3%), and maintenance (23%). A 10-factor process model with two higher-order correlated factors (experiential and behavioral) provided the best data fit (chi2 = 1446.12; df = 366; p < .0001; comparative fit index [CFI] = .89; standardized root mean square residual [SRMR] = .05). The self-efficacy structure fit the data well (chi 2 = 81.86; df = 9; p < .0001; CFI = .94; SRMR = .04), as did the decisional balance structure (chi2 = 37.42; df = 19; p = .007; CFI = .99; SRMR = .02). Processes, self-efficacy, decisional balance, and fruit/vegetable consumption behavior differed significantly by stage, with medium effect sizes for most variables.

CONCLUSION

The variables revealed adequate fit to the theorized measurement models. TTM predictions regarding stage differences in self-efficacy, pros and cons, and fruit/vegetable consumption were confirmed; however, most experiential and behavioral processes increased in the early stages and then leveled off.

Design and outcomes of a Mothers In Motion behavioral intervention pilot study

OBJECTIVE

This paper describes the design and findings of a pilot Mothers In Motion (P-MIM) program.

DESIGN

A randomized controlled trial that collected data via telephone interviews and finger stick at 3 time points: baseline and 2 and 8 months post-intervention.

SETTING

Three Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) sites in southern Michigan.

PARTICIPANTS

One hundred and twenty nine overweight and obese African-American and white mothers, 18-34 years old.

INTERVENTION

The 10-week, theory-based, culturally sensitive intervention messages were delivered via a series of 5 chapters on a DVD and complemented by 5 peer support group teleconferences.

MAIN OUTCOME MEASURES

Dietary fat, fruit, and vegetable intake; physical activity; stress; feelings; body weight; and blood glucose.

ANALYSIS

General linear mixed model was applied to assess treatment effects across 2 and 8 months post-intervention.

RESULTS

No significant effect sizes were found in primary and secondary outcome variables at 2 and 8 months post-intervention. However, changes in body weight and blood glucose showed apparent trends consistent with the study's hypotheses.

CONCLUSIONS AND IMPLICATIONS

The P-MIM showed promise for preventing weight gain in low-income overweight and obese women. However, a larger experimental trial is warranted to determine the effectiveness of this intervention.

Differential trends in weight-related health behaviors among American young adults by gender, race/ethnicity, and socioeconomic status: 1984-2006

OBJECTIVES

We investigated temporal patterns from 1984 to 2006 in 6 weight-related health behaviors by using longitudinal data for multiple cohorts of young adults (aged 19-26 years) from the nationally representative Monitoring the Future Study.

METHODS

We used growth curve models to examine historical trends in 6 health behaviors: frequency of eating breakfast, eating green vegetables, eating fruit, exercising, watching television, and sleeping 7 hours each night. Variations across gender, race/ethnicity, and socioeconomic status were investigated.

RESULTS

Frequency of exercising was consistently lower among young adult women than young adult men over this 23-year period. Compared with White women, Hispanic women, and women from other race/ethnic groups, Black women showed declines in the frequency of exercise since 1984. In general, young adult women showed a marked increase in the frequency of eating breakfast over this period, although Black women did not show any net gains.

CONCLUSIONS

Social disparities in body weight may increase because Black women, Hispanic women, and men with lower socioeconomic status show declining trends in positive weight-related health behaviors compared with White young adults with higher socioeconomic status.

Mixed method approaches to understanding cancer-related dietary risk reduction among public housing residents

Improving diet is one important pathway for addressing cancer disparities. We conducted mixed-method analyses of 468 24-h dietary recalls from 156 African-American women residents of Washington DC public housing to better understand dietary patterns. Recalls were rated for five cancer-related preventive characteristics (adequate fruits/vegetables, moderate fat, moderate calories, no alcohol, and adequate Healthy Eating Index score), combined as a scale. Bivariate and multivariate analyses identified psychosocial and dietary characteristics associated with scale scores. Qualitative analyses of dietary records identified contextual aspects of food patterns within and across score groups. Sixty-one percent of respondents met zero or one dietary goal; alcohol abstention was most common (64%). Only 12% achieve either three (6%), four (4%), or all five (<1%) goals; five fruit and vegetable servings were least common (15%). The underlying scalar structure of responses suggests that fruit and vegetable consumption is seldom achieved in this population without other scale components. Poorer scores were associated with younger age, depressive symptoms, stressful life events, smoking, and food-purchasing practices. Qualitative analyses identified eight themes related to differences between dietary patterns. Findings reinforce the value of nonreductionist approaches to cancer-related nutrition intervention.

Fruit and vegetable consumption and its recommended intake associated with sociodemographic factors: Thailand National Health Examination Survey III

OBJECTIVE

To examine the fruit and vegetable consumption in Thailand, the percentage of Thais meeting recommended intakes and the association with sociodemographic factors.

DESIGN

Cross-sectional survey with a stratified, three-stage, cluster probability sampling design.

SETTING

Community-dwelling men and women participating in the Thailand National Health Examination Survey III.

SUBJECTS

A total of 39 290 individuals aged >or=15 years were interviewed using a questionnaire to obtain information on sociodemographic characteristics and fruit and vegetable consumption. Daily fruit and vegetable consumption was estimated through the use of a short semi-qualitative FFQ.

RESULTS

Overall, participants had average frequencies of fruit and vegetable consumption equal to 4.56 and 5.97 d/week, respectively. Average daily number of servings of fruit, vegetables and fruit plus vegetables were 1.46, 1.78 and 3.24, respectively. Intake amounts of fruit, vegetables and fruit plus vegetables varied by marital status and region, and were lower among males (except for vegetable intake), those of older age, those with low educational attainment, those with low monthly household income and those living in a rural area. Only 1/3, 1/4 and 1/4 of the population consumed the recommended >or=2, >or=3 and >or=5 servings/d for fruit, vegetables and fruit plus vegetables. Sociodemographic factors related to meeting the recommended intake of >or=5 servings/d for fruit plus vegetables included being female (OR = 1.13) and household income >or=50,000 Baht/month (OR = 1.66).

CONCLUSIONS

The amounts of fruit and vegetables consumed by Thai participants were far below the level of current recommendations. Public education and campaigns on adequate consumption of fruits and vegetables should be targeted more towards low socio-economic groups.

Pass the fruits and vegetables! A community-university-industry partnership promotes weight loss in African American women

This article describes a community-university-industry partnership to alleviate food insecurity while promoting weight loss. Twenty-one overweight African American women are randomly assigned to experimental or control groups. Each receives supermarket gift cards and brief health education monthly for 3 months. The experimental group buys fresh produce only, whereas the control group buys any groceries. Data on weight, body mass index (BMI), waist-hip circumferences, and dietary intake are collected at baseline and months 1 to 3. Nine (43%) have complete data. Quantitative data reveal that the experimental group have lost significantly more weight (-6, +4 lbs), significantly reduced BMI (-1, +0.7), and eat significantly more raw, fresh produce (1.29, 0.15 cups). A focus group held at month 4 is rich with the meanings of participating, eating "well," and forming new habits. A nutrient-dense diet that is calorically balanced is the hallmark of health and well-being and may be related to weight loss in new ways. However, this diet is not always affordable by those most in need of it. The unexpected outcome of a statistical relationship among consuming raw, freshly prepared produce, weight loss, and BMI reduction within 3 months is not altogether explainable. There are obvious benefits, however, to these outcomes that support the continuing study of the phenomenon.

Fruit and vegetable dietary behavior in response to a low-intensity dietary intervention: the rural physician cancer prevention project

CONTEXT

Increased fruit and vegetable intake can reduce cancer risk. Information from this study contributes to research exploring health disparities in high-risk dietary behavior.

PURPOSE

Changes in fruit and vegetable behavior were evaluated to assess the effects of a low-intensity, physician-endorsed dietary intervention in a rural population.

METHODS

The study was a randomized trial of 754 patients from 3 physician practices in rural Virginia. Low-literacy nutrition education materials and personalized dietary feedback were administered by mail and telephone. Mixed model analysis of variance was used to determine the effect of the intervention on fruit and vegetable intake behavior, knowledge, intentions, and self-efficacy at 1, 6, and 12 months.

FINDINGS

The intervention effect was moderated by age, race, sex, and education. Intake at 1 and 6 months was increased for older and younger participants and those with some college, and further maintained at 12 months by those who did not complete high school. African Americans in the intervention group displayed significantly greater intentions to increase fruit/vegetable intake than whites/others. Knowledge of fruit/vegetable recommendations significantly increased in the intervention group at 12 months, particularly for men.

CONCLUSIONS

For the rural population, a low-intensity physician-endorsed self-help dietary intervention was successful in initiating fruit and vegetable dietary changes at 1 and 6 months post-intervention, and increasing intentions to change in African Americans. The relationship of the moderating effects of age, race, sex and education need to be further explored in relation to dietary intervention and dietary behavior change for the rural population.

The Epidemiology of Childhood Leukemia with a Focus on Birth Weight and Diet

Leukemia is the most common childhood cancer and a major source of morbidity and mortality. The etiology of childhood leukemia remains largely unknown. Cytogenetic abnormalities determine disease subtypes, prognosis, clinical presentation, and course and may help in discovering etiological factors. Epidemiologic investigations of leukemia are complicated by many factors, including the rarity of the disease, necessitating careful study design. Two emerging areas of interest in leukemia etiology are birth weight and diet. High birth weight has been associated with increased risk of childhood leukemia. The biological mechanism behind this association may involve insulin-like growth factor I (IGF-I), which is associated with high birth weight. IGF-I may act by increasing the absolute number of stem cells available for transformation, stimulating the growth of cells that are already transformed, or a combination of effects. Diet has been linked with leukemia. Maternal dietary DNA topoisomerase II (DNAt2) inhibitor intake is associated with infant acute myeloid leukemia (AML) with the MLL gene translocation. Increased intake of fruits and vegetables has been associated with decreased leukemia risk and, relatedly, lack of maternal folate supplementation has been associated with increased childhood leukemia risk, possibly by causing DNA hypomethylation and increased DNA strand breaks. Methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms modify this risk.

Louisiana (LA) Health: design and methods for a childhood obesity prevention program in rural schools

There is a worldwide epidemic of obesity with far-reaching consequences for the health of our nation. Prevention of obesity, especially in children, has been deemed by public health policy makers to be one of the most important objectives for our country. This prevention project, called Louisiana (LA) Health, will test whether modification of environmental and behavioral factors can prevent inappropriate weight gain in children from rural parishes of Louisiana who are enrolled in the fourth to sixth grades during Year 1. The primary aim of the LA Health project is to test the efficacy of two school-based approaches for obesity prevention: primary prevention alone and a combination of primary and secondary prevention which will be compared to a no-intervention control group using a cluster randomization research design, with 17 school clusters randomly assigned to the three treatment arms. The study will span 3 years and will provide critical tests of strategies that: 1) modify the child's environment as a primary prevention strategy and 2) provide health behavior modification via classroom instruction and internet counseling as a secondary prevention strategy. The study will also recruit a similar sample of students to measure changes in body weight relative to height, gender, and age over the same three-year period.