Conceptualization and Assessment of 24-H Timing of Eating and Energy Intake: A Methodological Systematic Review of the Chronic Disease Literature

Timing of eating (TOE) and energy intake (TOEI) has important implications for chronic disease risk beyond diet quality. The 2020 Dietary Guidelines Advisory Committee recommended developing consistent terminology to address the lack of TOE/TOEI standardization. The primary objective of this methodological systematic review was to characterize the conceptualization and assessment of TOE/TOEI within the chronic disease literature (International Prospective Register of Systematic Reviews registration number: CRD42021236621). Literature searches in Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, Embase, PubMed, and Scopus were limited to English language publications from 2000 to August 2022. Eligible studies reported the association between TOE/TOEI and obesity, cardiovascular disease, type 2 diabetes mellitus, cancer, or a related clinical risk factor among adults (≥19 y) in observational and intervention studies. A qualitative synthesis described and compared TOE/TOEI conceptualization, definitions, and assessment methods across studies. Of the 7579 unique publications identified, 259 studies (observational [51.4 %], intervention [47.5 %], or both [1.2 %]) were eligible for inclusion. Key findings indicated that most studies (49.6 %) were conducted in the context of obesity and body weight. TOE/TOEI variables or assigned conditions conceptualized interrelated aspects of time and eating or energy intake in varying ways. Common TOE/TOEI conceptualizations included the following: 1) timepoint (specific time to represent when intake occurs, such as time of breakfast [74.8 %]); 2) duration (length of time or interval when intake does/does not occur, such as "eating window" [56.5 %]); 3) distribution (proportion of daily intake at a given time interval, such as "percentage of energy before noon" [29.8 %]); and 4) cluster (grouping individuals based on temporal ingestive characteristics [5.0 %]). Assessment, definition, and operationalization of 24-h TOE/TOEI variables varied widely across studies. Observational studies most often used surveys or questionnaires (28.9 %), whereas interventions used virtual or in-person meetings (23.8 %) to assess TOE/TOEI adherence. Overall, the diversity of terminology and methods solidifies the need for standardization to guide future research in chrononutrition and to facilitate inter-study comparisons.

Salmon Food-Specific Compounds and Their Metabolites Increase in Human Plasma and Are Associated with Cardiometabolic Health Indicators Following a Mediterranean-Style Diet Intervention

BACKGROUND

Nutrimetabolomics allows for the comprehensive analysis of foods and human biospecimens to identify biomarkers of intake and begin to probe their associations with health. Salmon contains hundreds of compounds that may provide cardiometabolic benefits.

OBJECTIVES

We used untargeted metabolomics to identify salmon food-specific compounds (FSCs) and their predicted metabolites that were found in plasma after a salmon-containing Mediterranean-style (MED) diet intervention. Associations between changes in salmon FSCs and changes in cardiometabolic health indicators (CHIs) were also explored.

METHODS

For this secondary analysis of a randomized, crossover, controlled feeding trial, 41 participants consumed MED diets with 2 servings of salmon per week for 2 5-wk periods. CHIs were assessed, and fasting plasma was collected pre- and postintervention. Plasma, salmon, and 99 MED foods were analyzed using liquid chromatography-mass spectrometry-based metabolomics. Compounds were characterized as salmon FSCs if detected in all salmon replicates but none of the other foods. Metabolites of salmon FSCs were predicted using machine learning. For salmon FSCs and metabolites found in plasma, linear mixed-effect models were used to assess change from pre- to postintervention and associations with changes in CHIs.

RESULTS

Relative to the other 99 MED foods, there were 508 salmon FSCs with 237 unique metabolites. A total of 143 salmon FSCs and 106 metabolites were detected in plasma. Forty-eight salmon FSCs and 30 metabolites increased after the intervention (false discovery rate <0.05). Increases in 2 annotated salmon FSCs and 2 metabolites were associated with improvements in CHIs, including total cholesterol, low-density lipoprotein cholesterol, triglycerides, and apolipoprotein B.

CONCLUSIONS

A data-driven nutrimetabolomics strategy identified salmon FSCs and their predicted metabolites that were detectable in plasma and changed after consumption of a salmon-containing MED diet. Findings support this approach for the discovery of compounds in foods that may serve, upon further validation, as biomarkers or act as bioactive components influential to health. The trials supporting this work were registered at NCT02573129 (Mediterranean-style diet intervention) and NCT05500976 (ongoing clinical trial).

Perspective: A Research Roadmap about Ultra-Processed Foods and Human Health for the United States Food System: Proceedings from an Interdisciplinary, Multi-Stakeholder Workshop

Our objective was to convene interdisciplinary experts from government, academia, and industry to develop a Research Roadmap to identify research priorities about processed food intake and risk for obesity and cardiometabolic diseases (CMD) among United States populations. We convened attendees at various career stages with diverse viewpoints in the field. We held a "Food Processing Primer" to build foundational knowledge of how and why foods are processed, followed by presentations about how processed foods may affect energy intake, obesity, and CMD risk. Breakout groups discussed potential mechanistic and confounding explanations for associations between processed foods and obesity and CMD risk. Facilitators created research questions (RQs) based on key themes from discussions. Different breakout groups convened to discuss what is known and unknown for each RQ and to develop sub-RQs to address gaps. Workshop attendees focused on ultra-processed foods (UPFs; Nova Group 4) because the preponderance of evidence is based on this classification system. Yet, heterogeneity and subjectivity in UPF classification was a challenge for RQ development. The 6 RQs were: 1) What objective methods or measures could further categorize UPFs, considering food processing, formulation, and the interaction of the two? 2) How can exposure assessment of UPF intake be improved? 3) Does UPF intake influence risk for obesity or CMDs, independent of diet quality? 4) What, if any, attributes of UPFs influence ingestive behavior and contribute to excess energy intake? 5) What, if any, attributes of UPFs contribute to clinically meaningful metabolic responses? 6) What, if any, external environmental factors lead people to consume high amounts of UPFs? Uncertainty and complexity around UPF intake warrant further complementary and interdisciplinary causal, mechanistic, and methodological research related to obesity and CMD risk to understand the utility of applying classification by degree of processing to foods in the United States.

Chlorpyrifos fate in the Arctic: Importance of analyte structure in interactions with Arctic dissolved organic matter

The insecticide and current use pesticide chlorpyrifos (CLP) is transported via global distillation to the Arctic where it may pose a threat to this ecosystem. CLP is readily detected in Arctic environmental compartments, but current research has not studied its partitioning between water and dissolved organic matter (DOM) nor the role of photochemistry in CLP's fate in aquatic systems. Here, the partition coefficients of CLP were quantified with various types of DOM isolated from the Arctic and an International Humic Substances Society (IHSS) reference material Suwannee River natural organic matter (SRNOM). While CLP readily partitions to DOM, CLP exhibits a significantly higher binding constant with Arctic lacustrine DOM relative to fluvial DOM or SRNOM. The experimental partitioning coefficients (KDOC) were compared to a calculated value estimated using poly parameter linear free energy relationship (pp-LFER) and was found to be in good agreement with SRNOM, but none of the Arctic DOMs. We found that Arctic KDOC values decrease with increasing SUVA254, but no correlations were observed for the other DOM compositional parameters. DOM also mediates the photodegradation of CLP, with stark differences in photo-kinetics using Arctic DOM isolated over time and space. This work highlights the chemo-diversity of Arctic DOM relative to IHSS reference materials and highlights the need for in-depth characterization of DOM that transcends the current paradigm based upon terrestrial and microbial precursors.

Metabolomic Profiling of an Ultraprocessed Dietary Pattern in a Domiciled Randomized Controlled Crossover Feeding Trial

BACKGROUND

Objective markers of ultraprocessed foods (UPF) may improve the assessment of UPF intake and provide insight into how UPF influences health.

OBJECTIVES

To identify metabolites that differed between dietary patterns (DPs) high in or void of UPF according to Nova classification.

METHODS

In a randomized, crossover, controlled-feeding trial (clinicaltrials.govNCT03407053), 20 domiciled healthy participants (mean ± standard deviation: age 31 ± 7 y, body mass index [kg/m2] 22 ± 11.6) consumed ad libitum a UPF-DP (80% UPF) and an unprocessed DP (UN-DP; 0% UPF) for 2 wk each. Metabolites were measured using liquid chromatography with tandem mass spectrometry in ethylenediaminetetraacetic acid plasma, collected at week 2 and 24-h, and spot urine, collected at weeks 1 and 2, of each DP. Linear mixed models, adjusted for energy intake, were used to identify metabolites that differed between DPs.

RESULTS

After multiple comparisons correction, 257 out of 993 plasma and 606 out of 1279 24-h urine metabolites differed between UPF-DP and UN-DP. Overall, 21 known and 9 unknown metabolites differed between DPs across all time points and biospecimen types. Six metabolites were higher (4-hydroxy-L-glutamic acid, N-acetylaminooctanoic acid, 2-methoxyhydroquinone sulfate, 4-ethylphenylsulfate, 4-vinylphenol sulfate, and acesulfame) and 14 were lower following the UPF-DP; pimelic acid, was lower in plasma but higher in urine following the UPF-DP.

CONCLUSIONS

Consuming a DP high in, compared with 1 void of, UPF has a measurable impact on the short-term human metabolome. Observed differential metabolites could serve as candidate biomarkers of UPF intake or metabolic response in larger samples with varying UPF-DPs. This trial was registered at clinicaltrials.gov as NCT03407053 and NCT03878108.

Food Processing, According to the Nova Classification System, and Dietary Intake of US Infants and Toddlers

BACKGROUND

High intake of ultra-processed foods (UPFs) is associated with increased risk of chronic disease; thus, it is important to understand how UPFs influence diet quality early in life.

OBJECTIVES

We describe complementary foods and beverages (CFBs) according to the Nova Classification System of Food Processing for infants and toddlers in the United States and estimate how Nova groups and subgroups contribute to energy and select nutrients and food groups.

METHODS

We used day 1 24-h recall from infants and toddlers aged 6-23 mo from the cross-sectional, nationally representative 2013-18 National Health and Nutrition Examination Survey (n = 1140). We estimated contributions of Nova groups and subgroups to energy and select nutrients and food groups consumed as CFBs (excluding human milk and formula) using the population ratio with weighted survey commands in SAS.

RESULTS

For infants and toddlers in the United States, 42 ± 0.9% (mean ± standard error of the mean) of energy intake from CFBs came from unprocessed/minimally processed foods (U/MPFs) and 45 ± 0.8% from UPFs. U/MPFs contributed most to nutrient intakes (except iron, zinc, and sodium); ≥20% of all selected nutrients was from UPFs. UPFs contributed most to iron (75 ± 1.0%) and zinc (48 ± 1.3%); breakfast cereals were the top source. Most fruit, vegetables, and dairy were from U/MPFs. More than 80% of total grains, whole grains, refined grains, and added sugars were UPFs.

CONCLUSIONS

U/MPFs support healthy dietary intake of infants and toddlers in the United States, whereas UPFs contribute meaningfully to nutrients and food groups to be encouraged (iron, zinc, and whole grains), as well as some that should be limited (added sugars and sodium). More research is needed to better understand the utility and sensitivities of using Nova for providing dietary guidance for infants and toddlers in the United States.

Identifying and Estimating Ultraprocessed Food Intake in the US NHANES According to the Nova Classification System of Food Processing

BACKGROUND

The degree of food processing may be an important dimension of diet in how it relates to health outcomes. A major challenge is standardizing food processing classification systems for commonly used datasets.

OBJECTIVES

To standardize and increase transparency in its application, we describe the approach used to classify foods and beverages according to the Nova food processing classification in the 24-h dietary recalls from the 2001-2018 cycles of What We Eat in America (WWEIA), NHANES, and investigate variability and potential for Nova misclassification within WWEIA, NHANES 2017-2018 data via various sensitivity analyses.

METHODS

First, we described how the Nova classification system was applied to the 2001-2018 WWEIA, NHANES data using the reference approach. Second, we calculated the percentage energy from Nova groups [1: unprocessed or minimally processed foods, 2: processed culinary ingredients, 3: processed foods, and 4: ultraprocessed foods (UPFs)] for the reference approach using day 1 dietary recall data from non-breastfed participants aged ≥1 y from the 2017-2018 WWEIA, NHANES. We then conducted 4 sensitivity analyses comparing potential alternative approaches (e.g., opting for more vs. less degree of processing for ambiguous items) to the reference approach, to assess how estimates differed.

RESULTS

The energy contribution of UPFs using the reference approach was 58.2% ± 0.9% of the total energy; unprocessed or minimally processed foods contributed 27.6% ± 0.7%, processed culinary ingredients contributed 5.2% ± 0.1%, and processed foods contributed 9.0% ± 0.3%. In sensitivity analyses, the dietary energy contribution of UPFs ranged from 53.4% ± 0.8% to 60.1% ± 0.8% across alternative approaches.

CONCLUSIONS

We present a reference approach for applying the Nova classification system to WWEIA, NHANES 2001-2018 data to promote standardization and comparability of future research. Alternative approaches are also described, with total energy from UPFs differing by ∼6% between approaches for 2017-2018 WWEIA, NHANES.

Scoping Review and Evidence Map of the Relation between Exposure to Dietary Sweetness and Body Weight-Related Outcomes in Adults

Numerous governmental and health organizations recommend reduced intake of added sugars due to the health risks associated with excess intake, including the risk of obesity. Some organizations further recommend avoiding dietary sweetness, regardless of the source. A scoping review and evidence map were completed to characterize the research that investigated associations between dietary sweetness and body weight. The aim was to identify and map published studies that have investigated total dietary sweetness, sweet food/beverages, sugar, or sweetener intake, and body weight-related outcomes and/or energy intake. Using preregistered search terms (osf.io/my7pb), 36,779 publications (duplicates removed) were identified from PubMed, Cochrane Library, and Scopus and screened for inclusion. Eligible studies were clinical trials, longitudinal cohorts, case-control studies, cross-sectional studies, and systematic reviews conducted among adults (age ≥18 y), which were performed to investigate associations between dietary sweetness, sweet foods/beverages, sugar, or sweetener (energetic or nonenergetic) intake and body weight, BMI, adiposity, and/or energy intake. A total of 833 eligible publications were identified, detailing 804 studies. Only 7 studies (0.9% of included studies; 2 clinical trials, 4 cross-sectional studies, and 1 with another design type) investigated associations between total dietary sweetness and body weight-related outcome and/or energy intake. An additional 608 (75.6%) studies investigated intakes of sweet foods/beverages, sugar, or sweetener, and body weight-related outcomes and/or energy intake, including 225 clinical trials, 81 longitudinal cohorts, 4 case-control studies, and 280 cross-sectional studies. Most studies (90.6%) did not measure the sweetness of the diet or individual foods consumed. Ninety-two (11.4%) publications reported data from studies on dietary patterns that included sweet foods/beverages alongside other dietary components and 97 (12.1%) systematic reviews addressed different but related research questions. Although there is a breadth of evidence from studies that have investigated associations between intakes of sweet foods and beverages, sugars, and sweeteners and body weight, there is a limited depth of evidence on the association between total dietary sweetness and body weight.

Top sources and trends in consumption of total energy and energy from solid fats and added sugars among youth aged 2-18 years: United States 2009-2018

BACKGROUND

High energy intake from non-nutrient-dense sources correlates with poorer diet quality.

OBJECTIVES

The aims were to 1) estimate total energy intake and energy from solid fats and added sugars combined (SoFAS) and identify their top food category sources for ages 2-18 y in 2015-2018 and 2) describe trends over time in 2009-2018.

METHODS

Data were from the NHANES. Pairwise differences were examined using univariate t statistics (2015-2018, n = 5038), and trends by age and over time (2009-2018, n = 14,038) were examined using orthogonal polynomials.

RESULTS

In 2015-2018, SoFAS contributed a mean (SE) of 30.0% (0.3%) of total energy. Solid fats [16.1% (0.2%)] and added sugars [13.8% (0.2%)] each contributed >10%. The contribution of added sugars increased with age from 11.1% (2-3 y) to 14.4% (14-18 y), and was higher for all other race/Hispanic origins than non-Hispanic Asians. The top 5 sources of energy were sweet bakery products, savory snacks, pizza, other mixed dishes, and unflavored milk, and for SoFAS also included soft drinks, other desserts, candy, and snack bars. Total energy did not change between 2009 and 2018, but energy from SoFAS, and servings of solid fats, and added sugars declined. The contribution of unflavored milk to total energy declined for all ages and most race/Hispanic origins. Fruit drinks (all ages) and soft drinks (9-18 y) remained among top added sugars sources despite declines. The contribution of sweet bakery products to energy from SoFAS increased for most ages and candy and snack bars to energy from added sugars.

CONCLUSIONS

In 2015-2018, SoFAS contributed >30% of total energy for ages 2-18 y, which doubled the Dietary Guidelines for Americans' recommended limit of 15%. The top 5 sources of total energy were similar to those of solid fats, and those of SoFAS similar to those of added sugars. These results may inform public health efforts for improving diet quality.

Understanding responses to different types of conflicting information about cancer prevention

BACKGROUND

Individuals are regularly exposed to conflicting information about health; however, understanding of how individuals respond to different types of conflicting information is limited.

METHODS

In total, 1027 US adults were randomly assigned to 1 of 8 conflicting information messages about nutrition and cancer risk, depicting 1/4 conflicting information types (conflict in evidence - sources A and B agree the evidence is mixed; conflict between two expert sources - sources A and B present conflicting evidence about nutrition and cancer risk; conflict within the same expert source - source A changes its own recommendation about the evidence; no conflict control) crossed by 1/2 baseline recommendations with which new information conflicted (limit vs. do not limit red meat intake to reduce cancer risk).

RESULTS

Compared to the control, each conflicting information type led to lower perceived scientific consensus about how much red meat one should eat (p < .001); conflict in evidence (p = .004) and between sources (p = .006) led to lower trust in scientists. Intentions to consume red meat more frequently were higher in the conflicting information conditions than control in the group initially told to "limit red meat" and lower in the "do not limit red meat" group (p = .022). Conflict within the same source led to higher perceived scientific consensus compared to conflict in evidence (p = .007) and between sources (p = .013); it also lowered intentions to consume red meat more frequently compared to conflict in evidence, but only in the "do not limit red meat" condition (p = .033). Conflict in evidence (p = .007) and within the same source (p = .013) increased cancer fatalism compared to conflict between sources.

CONCLUSIONS

Conflict in scientific evidence and conflict arising from the same expert source (e.g., a changing public health guideline) may have pernicious effects. Future efforts could investigate how best to publicly communicate these instances of scientific conflict to minimize negative impact.

Red and processed meat intakes and cardiovascular disease and type 2 diabetes mellitus: An umbrella systematic review and assessment of causal relations using Bradford Hill's criteria

Observational research suggests higher red and processed meat intakes predict greater risks of developing or dying from cardiovascular diseases (CVD) and type 2 diabetes mellitus (T2DM), but this research limits causal inference. This systematic review of reviews utilizes both observational and experimental research findings to infer causality of these relations. Reviews from four databases were screened by two researchers. Reviews included unprocessed red meat (URM), processed meat (PM), or mixed URM + PM intake, and reported CVD or T2DM outcomes. Twenty-nine reviews were included, and causality was inferred using Bradford Hill's Criteria. Observational assessments of CVD outcomes and all meat types consistently reported weak associations while, T2DM outcomes and PM and Mixed URM + PM assessments consistently reported strong associations. Experimental assessments of Mixed URM + PM on CVD and T2DM risk factors were predominately not significant which lacked coherence with observational findings. For all meat types and outcomes, temporality and plausible mechanisms were established, but specificity and analogous relationships do not support causality. Evidence was insufficient for URM and T2DM. More experimental research is needed to strengthen these inferences. These results suggest that red and processed meat intakes are not likely causally related to CVD but there is potential for a causal relationship with T2DM.

Intake of Salmon Fillets Elevates Plasma Astaxanthin Levels in Human Subjects

Objectives

Salmon is a commonly consumed fish rich in astaxanthin carotenoids and polyunsaturated fatty acids with inflammatory and metabolic benefits. This study investigated concentrations of astaxanthin and fatty acids from salmon type (wild vs. farmed) and temperature changes (raw vs. cooked), and the effect of salmon consumption on human plasma astaxanthin concentration as part of a Mediterranean-style eating pattern (MED).

Methods

For the salmon analysis, three wild-caught and three farmed salmon fillets were randomly selected from local vendors. Methanol extracts of salmon fillets were subject to fatty acids and astaxanthin analyses by GC-MS and LC-MS QTOF, respectively. We then analyzed lipophilic plasma compounds via LC-QTOF MS from 41 overweight and obese adults who participated in a randomized crossover feeding trial. Participants consumed MED for five weeks, consumed their self-chosen diets for 4 weeks (washout), then consumed another MED for an additional five weeks; MED interventions differed by the amount of red meat consumed. Both MED contained 2 servings of salmon/week. ANOVA with a Tukey posthoc test was used.

Results

In the salmon analysis, astaxanthin (fold change 4.00, P = 0.0002), EPA (P = 0.005), and DHA (P = 0.01) concentrations were higher in wild-caught compared to farmed salmon, while ALA (P < 0.0001) and AA (P = 0.002) were higher in farmed salmon. Cooking (baking) did not cause significant changes in astaxanthin concentrations. In the human plasma samples, astaxanthin was higher (P = 0.001) after the MED, in which farmed salmon was consumed for five weeks. Astaxanthin concentrations decreased (P = 0.02) back to baseline amounts after the 4-week washout and increased again (P = 0.001) after the second dietary intervention. LC-QTOF MS analysis of all MED foods consumed showed that astaxanthin was discovered in salmon only.

Conclusions

Wild salmon tend to have higher amounts of health-promoting compounds which were unaffected by cooking. Concentrations of astaxanthin in human plasma were responsive to changes in salmon intake.

Funding Sources

USDA NIFA 2020–67,017-30,842, NIH 5R01DK113957, and Beef Checkoff (MED feeding study).

Heterogeneity in Meat Food Groups Can Meaningfully Alter Population-Level Intake Estimates of Red Meat and Poultry

Heterogeneity in meat food groups hinders interpretation of research regarding meat intake and chronic disease risk. Our objective was to investigate how heterogeneity in red meat (RM) and poultry food groups influences US population intake estimates. Based on a prior systematic review, we created an ontology of methods used to estimate RM [1= unprocessed RM; 2 (reference)= unprocessed RM + processed RM; 3= unprocessed RM + processed RM + processed poultry; and 4=unprocessed RM + processed RM + processed poultry + chicken patties/nuggets/tenders (PNT)] and three for poultry [A=unprocessed poultry; B= unprocessed poultry + PNT; C (reference)= unprocessed poultry + processed poultry + PNT). We applied methods to 2015-18 National Health and Nutrition Examination Survey data to estimate RM and poultry intake prevalence and amount. We estimated and compared intakes within RM and within poultry methods via the NCI Method for individuals ≥2 years old (n = 15,038), adjusted for age, sex, and race/Hispanic origin. We compared the population percentage that exceeded age- and sex-specific RM and poultry allotments from the Dietary Guidelines for Americans recommended eating patterns. The percent that consumed RM ranged from 47 ± 1.2% to 75 ± 0.8% across methods and mean amount ranged from 10.5 ± 0.28 to 18.2 ± 0.35 lean oz-equivalents/week; 38 ± 1.2% to 71 ± 0.7% and 9.8 ± 0.35 to 13.3 ± 0.35 lean oz-equivalents/week across poultry methods. Estimates for higher, but not lower, intake percentiles differed across RM methods. Compared to the reference, Method 1 was ≥3.0 oz-equivalents/week lower from 20th-70th percentiles, ≥6.0 oz-equivalents/week lower from 75th-90th percentiles, and ≥9.0 oz-equivalents/week lower for the 95th percentile. Method 4, but not Method 3, was ≥3.0 oz-equivalents/week higher than the reference from 50 to 95th percentiles. The population percentage that exceeded allotments was 27 ± 1.8% lower for Method 1, 9 ± 0.8% higher for Method 3, and 14 ± 0.9% higher for Method 4 compared to the reference. Differences were less pronounced for poultry. Our analysis quantifies the magnitude of bias introduced by heterogeneous meat food group methodology. Explicit descriptions of meat food groups are important for development of dietary recommendations to ensure that research studies are compared appropriately.

A Standardized Assessment of Processed Red Meat and Processed Poultry Intake in the US Population Aged ≥2 Years Using NHANES

BACKGROUND

Standardized methods are needed to investigate intake patterns of processed meat subtypes, considering health concerns surrounding processed meat intake.

OBJECTIVES

The objectives of this study were to create a standardized method of disaggregating processed meat into processed red meat and processed poultry and describe intake patterns of the US population aged ≥2 y.

METHODS

Two researchers independently manually disaggregated processed meat from the Food Patterns Equivalents Database into processed red meat and processed poultry based on available information from the Foods and Nutrient Database for Dietary Studies. We created an SAS program (called Processed Meat Categories) to mimic the manual coding. We used the program to describe intake patterns and trends over time of processed red meat and processed poultry using 24-h recalls from 2007-2008 through 2017-2018 NHANES data with SAS survey-weighted procedures for complex surveys.

RESULTS

The SAS program had high agreement with the manual code (Pearson concordance correlation ≥0.95). Of the US population aged ≥2 y, 46.8% (95% CI: 45.3, 48.2%) reported consuming any processed meat, 42.5% (95% CI: 41.0, 43.9%) reported consuming processed red meat, and 11.3% (95% CI: 10.2, 12.4%) reported consuming processed poultry. Most [74.1 ± 0.13% (SEM)] processed meat reported was red meat compared with poultry, and 32.1 ± 0.01% of total red meat and 13.7 ± 0.01% of total poultry reported were processed. Prevalence of processed poultry intake increased from 9.5% (95% CI: 8.9, 10.1%) in 2007-2010 to 11.3% (95% CI: 10.2, 12.4%) in 2015-2018 (P < 0.0001), but mean intake amount did not change. Prevalence of processed red meat intake did not change over time, but mean intake decreased from 0.8 ± 0.03 ounce-equivalents in 2007-2010 to 0.7 ± 0.02 ounce-equivalents (P = 0.0058) in 2015-2018.

CONCLUSIONS

The Processed Meat Categories SAS program is a tool available for researchers to standardize estimates of processed meat subtypes for future dietary patterns research. Intake of total processed meat did not change in the United States, but intake amount of processed red meat decreased and the prevalence of processed poultry consumers increased.

Nonfood Prebiotic, Probiotic, and Synbiotic Use Has Increased in US Adults and Children From 1999 to 2018

BACKGROUND & AIMS

Public interest in pre-, pro-, and synbiotic products is increasing because of interactions between gut microbiota and human health. Our aim was to describe nonfood (from dietary supplements or medication) pre-, pro-, and synbiotic use by US adults and children and reported reasons.

METHODS

Using data from the National Health and Nutrition Examination Survey (NHANES), we text-mined dietary supplement and prescription medication labels and ingredients to identify pre-, pro-, and synbiotic products used in the past 30 days. We describe trends in use from 1999 to 2018 (n = 101,199) and prevalence in 2015-2016 and 2017-2018 (n = 19,215) by age groups, sex, ethnicity/race, education, income, self-reported diet and health quality, and prescription gastrointestinal medication use stratified by children (<19 years) and adults (19+ years).

RESULTS

Nonfood pre-, pro-, and synbiotic use increased up to 3-fold in recent cycles. Prevalence of use for all ages for prebiotics was 2.4% (95% confidence interval [CI], 2.0-2.9), for probiotics was 4.5% (95% CI, 3.5-5.6), and for synbiotics was 1.1% (95% CI, 0.8-1.5). Use was highest among older adults (8.8% [95% CI, 5.4-13.3] among those aged 60-69 years for probiotics), non-Hispanic Whites, those with higher educational attainment and income, those with more favorable self-reported diet or health quality, and those with concurrent prescription gastrointestinal medication use. The top reasons for use were for digestive health and to promote/maintain general health. Less than 30% reported using these products based on a health care provider's recommendation.

CONCLUSIONS

One in 20 US adults or children use nonfood pre-, pro-, or synbiotic products, and use has sharply increased in recent years. Most individuals voluntarily take these products for general digestive or overall health reasons.

Predictors of Palliative Care Knowledge: Findings from the Health Information National Trends Survey

BACKGROUND

Palliative care plays an important role in improving the quality of life for patients with cancer and their caregivers and has been associated with increased patient satisfaction. However, palliative care knowledge in the general population is limited, and often physician referral occurs late in prognosis. The objective of this analysis was to examine factors associated with palliative care knowledge.

METHOD

Using data from the 2018 NCI's Health Information National Trends Survey (HINTS) 5 Cycle 2, descriptive statistics, bivariate analyses, and multivariable logistic regressions were used to assess factors associated with respondents' palliative care knowledge using ORs and 95% confidence intervals as measures of association. The outcome of interest was measured with the item "How would you describe your level of knowledge about palliative care?" Possible response selections were "I've never heard of it," "I know a little bit about palliative care," and "I know what palliative care is and could explain it to someone else." To reduce the risk of type 1 error, jackknife variance estimations with repeated replications were used. All analyses were conducted with the SURVEYLOGISTIC command using SAS 9.4 (SAS Institute Inc.), and the statistical significance level was set at P < 0.05.

RESULTS

A total of 3,450 respondents (weighted sample size: 249,489,772) met the inclusion criteria. About 89% (n = 3,000) of all respondents had inadequate knowledge of palliative care. Multivariable analyses indicated that frequent health care utilization as defined as ≥ 2 times per year [OR, 3.01; 95% confidence interval (CI), 2.65-3.58], female gender (OR, 2.15; 95% CI, 1.31-3.59), being married (OR, 2.02; 95% CI, 1.14-3.59), having a college degree or higher (OR, 13.83; 95% CI, 1.71-12.04), and having a regular source of care (OR, 2.67; 95% CI, 1.37-1.90) had greater odds of adequate palliative care knowledge. Those without a cancer diagnosis were less likely to have adequate knowledge of palliative care (OR, 0.49; 95% CI, 0.41-0.89).

CONCLUSIONS

Knowledge of palliative care in the United States is low, particularly for those not already actively using their available healthcare system. Public health education efforts are needed to target subgroups of the U.S. population identified by this analysis to increase palliative care knowledge.

IMPACT

Healthcare providers have a major role to play in improving palliative care knowledge.

Effects of Total Red Meat Intake on Glycemic Control and Inflammatory Biomarkers: A Meta-Analysis of Randomized Controlled Trials

Our objective was to conduct a systematic review and meta-analysis to assess the effects of total red meat (TRM) intake on glycemic control and inflammatory biomarkers using randomized controlled trials of individuals free from cardiometabolic disease. We hypothesized that higher TRM intake would negatively influence glycemic control and inflammation based on positive correlations between TRM and diabetes. We found 24 eligible articles (median duration, 8 weeks) from 1172 articles searched in PubMed, Cochrane, and CINAHL up to August 2019 that included 1) diet periods differing in TRM; 2) participants aged ≥19 years; 3) included either men or women who were not pregnant/lactating; 4) no diagnosed cardiometabolic disease; and 5) data on fasting glucose, insulin, HOMA-IR, glycated hemoglobin (HbA1c), C-reactive protein (CRP), or cytokines. We used 1) a repeated-measures ANOVA to assess pre to post diet period changes; 2) random-effects meta-analyses to compare pre to post changes between diet periods with ≥ vs. <0.5 servings (35g)/day of TRM; and 3) meta-regressions for dose-response relationships. We grouped diet periods to explore heterogeneity sources, including risk of bias, using the National Heart, Lung, and Blood Institute's Quality Assessment of Controlled Interventions Studies. Glucose, insulin, and HOMA-IR values decreased, while HbA1c and CRP values did not change during TRM or alternative diet periods. There was no difference in change values between diet periods with ≥ vs. <0.5 servings/day of TRM [weighted mean differences (95% CIs): glucose, 0.040 mmol/L (-0.049, 0.129); insulin, -0.710 pmol/L (-6.582, 5.162); HOMA-IR, 0.110 (-0.072, 0.293); CRP, 2.424 nmol/L (-1.460, 6.309)] and no dose response relationships (P > 0.2). Risk of bias (85% of studies were fair to good) did not influence results. Total red meat consumption, for up to 16 weeks, does not affect changes in biomarkers of glycemic control or inflammation for adults free of, but at risk for, cardiometabolic disease. This trial was registered at PROSPERO as 2018 CRD42018096031.

Adherence to a Mediterranean-style eating pattern and risk of diabetes in a U.S. prospective cohort study

BACKGROUND

A Mediterranean-style eating pattern is consistently associated with a decreased diabetes risk in Mediterranean and European populations. However, results in U.S. populations are inconsistent. The objective of this study was to assess whether a Mediterranean-style eating pattern would be associated with diabetes risk in a large, nationally representative U.S. cohort of black and white men and women.

METHODS

Participants from the Atherosclerosis Risk in Communities study prospective cohort without diabetes, cardiovascular disease, or cancer at baseline (visit 1, 1987-1989; n = 11,991) were included (mean age 54 years, 56% female, 75% white). Alternate Mediterranean Diet scores (aMed) were calculated using the mean dietary intake self-reported at visit 1 and visit 3 (1993-1995) or visit 1 only for participants censored before visit 3. Participants were followed from visit 1 through 31 December 2016 for incident diabetes. We used Cox regression models to characterize associations of aMed (quintiles as well as per 1-point higher) with incident diabetes adjusted for energy intake, age, sex, race and study center, and education (Model 1) for all participants then stratified by race and body mass index (BMI). Model 2 included potential mediating behavioral and clinical measures associated with diabetes. Results are presented as hazard ratios and 95% confidence intervals.

RESULTS

Over a median follow-up of 22 years, there were 4024 incident cases of diabetes. Higher aMed scores were associated with lower diabetes risk [Model 1: 0.83 (0.73-0.94) for Q5 vs Q1 (p-trend < 0.001) and 0.96 (0.95-0.98) for 1-point higher]. Associations were stronger for black vs white participants (interaction p < 0.001) and weaker for obese vs normal BMI (interaction p < 0.01). Associations were attenuated but statistically significant in Model 2.

CONCLUSIONS

An eating pattern high in fruits, vegetables, whole grains, legumes, nuts, and fish, and moderate in alcohol was associated with a lower risk of diabetes in a community-based U.S.

POPULATION

Dietary Meat Categories and Descriptions in Chronic Disease Research Are Substantively Different within and between Experimental and Observational Studies: A Systematic Review and Landscape Analysis

This systematic review and landscape analysis describes patterns in dietary meat (skeletal muscle and associated tissues from mammalian, avian, and aquatic species; i.e., muscle foods) categories (CAT) and descriptions (DESCR) used throughout nutrition-related chronic disease literature, as there is anecdotally noted variation. A total of 1020 CAT and 776 DESCR were identified from 369 articles that assessed muscle food consumption and primary prevention of cardiovascular disease, obesity, type 2 diabetes, or cancer in adults ≥19 y from PubMed, Cochrane, and CINAHL up to March 2018. Specificity of CAT was analyzed on an empirical 1-7 ordinal scale as: 1) broad/undescriptive, "fish"; 2) muscle food type, "red meat"; 3) species, "poultry"; 4) broad + 1 descriptor, "processed meat"; 5) type/species + 1 descriptor, "fresh red meat"; 6) broad/type + 2 descriptors, "poached lean fish"; and 7) specific product, "luncheon meat." Median CAT specificity for randomized controlled trials (RCTs) and observational studies (OBSs) was 3 and 2 points out of 7, respectively, with no differences between chronic disease types. Specificity of OBS CAT was higher in recent articles but RCT CAT became less specific starting in the 2000s. RCT CAT were 400% more likely to include species, 500% more likely to include leanness, but 400% less likely to include processing degree compared with OBS CAT. A DESCR was included for 76% and 82% of OBS and RCT CAT, respectively. Researchers described processed meat, red meat, and total meat CAT more commonly than poultry or fish CAT. Among processed meat DESCR, 31% included a common term used in public regulatory definitions. In conclusion, muscle food categories and descriptions are substantively different within and between experimental and observational studies and do not match regulatory definitions. A practical muscle food classification system is warranted to improve interpretation of evidence regarding muscle food consumption and chronic disease.

Adopting a Mediterranean-Style Eating Pattern with Different Amounts of Lean Unprocessed Red Meat Does Not Influence Short-Term Subjective Personal Well-Being in Adults with Overweight or Obesity

Background

Reducing red meat intake is commonly recommended. Limited observational studies suggest that healthy eating patterns with red meat are associated with improved quality of life.

Objective

The secondary objectives of this randomized crossover controlled-feeding trial were to assess the effects of following a Mediterranean-style eating pattern (Med-Pattern) with different amounts of red meat on indexes of personal well-being (i.e., perceived quality of life, mood, and sleep) in overweight or obese adults. We hypothesized that following a Med-Pattern would improve these outcomes, independent of red meat intake amount.

Methods

Forty-one participants [aged 46 ± 2 y; body mass index (kg/m2): 30.5 ± 0.6; n = 28 women, n = 13 men) were provided Med-Pattern foods for two 5-wk periods separated by 4 wk of self-selected eating. The Med-Red Pattern contained ∼500 g/wk (typical US intake), and the Med-Control Pattern contained ∼200 g/wk (commonly recommended intake in heart-healthy eating patterns) of lean, unprocessed beef or pork compensated with mainly poultry and dairy. Baseline and postintervention outcomes measured were perceived quality of life via the MOS 36-Item Short-Form Health Survey, version 2 (SF-36v2), daily mood states via the Profile of Mood States (POMS), sleep perceptions via the Pittsburgh Sleep Quality Index, and sleep patterns via actigraphy. Data were analyzed via a doubly repeated-measures ANOVA adjusted for age, sex, and body mass at each time point.

Results

Following a Med-Pattern did not change domains of physical health, mental health, total mood disturbances, sleep perceptions, and sleep patterns but improved subdomains of physical health role limitations (SF-36v2: 93.6-96.7%; P = 0.038), vitality (SF-36v2: 57.9-63.0%; P = 0.020), and fatigue (POMS: 2.9-2.5 arbitrary units; P = 0.039). There were no differences between the Med-Red and Med-Control Patterns (time × pattern, P-interaction > 0.05).

Conclusion

Following a Med-Pattern, independent of lean, unprocessed red meat intake, may not be an effective short-term strategy to meaningfully improve indexes of personal well-being in adults who are overweight or obese. This trial was registered at clinicaltrials.gov as NCT02573129.

A Mediterranean-style eating pattern with lean, unprocessed red meat has cardiometabolic benefits for adults who are overweight or obese in a randomized, crossover, controlled feeding trial

Background

A Mediterranean-style eating pattern (Mediterranean Pattern) is often described as being low in red meat. Research shows that lean, unprocessed red meat can be incorporated into healthy eating patterns to improve cardiometabolic disease (CMD) risk factors.

Objective

We assessed the effects of consuming different amounts of lean, unprocessed red meat in a Mediterranean Pattern on CMD risk factors. We hypothesized that consuming a Mediterranean Pattern would improve CMD risk factors and that red meat intake would not influence these improvements.

Design

In an investigator-blinded, randomized, crossover, controlled feeding trial, 41 subjects [mean ± SD age: 46 ± 2 y; mean ± SD body mass index (kg/m2): 30.5 ± 0.6] were provided with a Mediterranean Pattern for two 5-wk interventions separated by 4 wk of self-selected eating. The Mediterranean Patterns contained ∼500 g [typical US intake (Med-Red)] and ∼200 g [commonly recommended intake in heart-healthy eating patterns (Med-Control)] of lean, unprocessed beef or pork per week. Red meat intake was compensated by poultry and other protein-rich foods. Baseline and postintervention outcomes included fasting blood pressure, serum lipids, lipoproteins, glucose, insulin, and ambulatory blood pressure. The presented results were adjusted for age, sex, and body mass at each time point (P < 0.05).

Results

Total cholesterol decreased, but greater reductions occurred with Med-Red than with Med-Control (-0.4 ± 0.1 and -0.2 ±0.1 mmol/L, respectively, intervention × time = 0.045]. Low-density lipoprotein decreased with Med-Red but was unchanged with Med-Control [-0.3 ± 0.1 and -0.1 ± 0.1 mmol/L, respectively, intervention × time = 0.038], whereas high-density lipoprotein (HDL) concentrations decreased nondifferentially [-0.1 ± 0.0 mmol/L]. Triglycerides, total cholesterol:HDL, glucose, and insulin did not change with either Med-Red or Med-Control. All blood pressure parameters improved, except during sleep, independent of the red meat intake amount.

Conclusions

Adults who are overweight or moderately obese may improve multiple cardiometabolic disease risk factors by adopting a Mediterranean-style eating pattern with or without reductions in red meat intake when red meats are lean and unprocessed. This trial was registered at clinicaltrials.gov as NCT02573129.

Broad and Inconsistent Muscle Food Classification Is Problematic for Dietary Guidance in the U.S

Dietary recommendations regarding consumption of muscle foods, such as red meat, processed meat, poultry or fish, largely rely on current dietary intake assessment methods. This narrative review summarizes how U.S. intake values for various types of muscle foods are grouped and estimated via methods that include: (1) food frequency questionnaires; (2) food disappearance data from the U.S. Department of Agriculture Economic Research Service; and (3) dietary recall information from the National Health and Nutrition Examination Survey data. These reported methods inconsistently classify muscle foods into groups, such as those previously listed, which creates discrepancies in estimated intakes. Researchers who classify muscle foods into these groups do not consistently considered nutrient content, in turn leading to implications of scientific conclusions and dietary recommendations. Consequentially, these factors demonstrate a need for a more universal muscle food classification system. Further specification to this system would improve accuracy and precision in which researchers can classify muscle foods in nutrition research. Future multidisciplinary collaboration is needed to develop a new classification system via systematic review protocol of current literature.

Photolysis and cellular toxicities of the organic ultraviolet filter chemical octyl methoxycinnamate and its photoproducts

Organic ultraviolet filter chemicals (UVFCs) are the active ingredients used in many sunscreens to protect the skin from UV light; these chemicals have been detected in numerous aquatic environments leading to concerns about how they might affect aquatic organisms and humans. One commonly used organic UVFC is octyl methoxycinnamate (OMC), better known by its commercial name, octinoxate. Upon exposure to UV light, OMC degrades rapidly, forming numerous photoproducts, some of which have been previously identified. In this study, we isolated and completely characterized the major products of OMC photolysis, including the two major stable OMC cyclodimers. One of these cyclodimers is a δ-truxinate, resulting from a head-to-head dimerization of two OMC molecules, and the other cyclodimer is an α-truxillate, resulting from a head-to-tail dimerization of two OMC molecules. Additionally, the cellular toxicities of the individual photoproducts were determined; it was found that the parent UVFC, OMC, 4-methoxybenzaldehyde, and two cyclodimers are significantly toxic to cells. The photoproduct 2-ethylhexanol is not cytotoxic, demonstrating that different components of OMC photolysate contribute differently to its cellular toxicity. This study thus provides an enhanced understanding of OMC photolysis and gives toxicity data that can be used to better evaluate OMC as a sunscreen agent.

Total red meat intake of ≥0.5 servings/d does not negatively influence cardiovascular disease risk factors: a systemically searched meta-analysis of randomized controlled trials

BACKGROUND

Observational associations between red meat intake and cardiovascular disease (CVD) are inconsistent. There are limited comprehensive analyses of randomized controlled trials (RCTs) that investigate the effects of red meat consumption on CVD risk factors.

OBJECTIVE

The purpose of this systematically searched meta-analysis was to assess the effects of consuming ≥0.5 or <0.5 servings of total red meat/d on CVD risk factors [blood total cholesterol (TC), LDL cholesterol, HDL cholesterol, triglycerides, ratio of TC to HDL cholesterol (TC:HDL), and systolic and diastolic blood pressures (SBP and DBP, respectively)]. We hypothesized that the consumption of ≥0.5 servings of total red meat/d would have a negative effect on these CVD risk factors.

DESIGN

Two researchers independently screened 945 studies from PubMed, Cochrane Library, and Scopus databases and extracted data from 24 qualified RCTs. Inclusion criteria were 1) RCT, 2) subjects aged ≥19 y, 3) consumption of ≥0.5 or <0.5 total red meat servings/d [35 g (1.25 ounces)], and 4) reporting ≥1 CVD risk factor. We performed an adjusted 2-factor nested ANOVA mixed-effects model procedure on the postintervention values of TC, LDL cholesterol, HDL cholesterol, TC:HDL cholesterol, triglycerides, SBP, and DBP; calculated overall effect sizes of change values; and used a repeated-measures ANOVA to assess pre- to postintervention changes.

RESULTS

Red meat intake did not affect lipid-lipoprotein profiles or blood pressure values postintervention (P > 0.05) or changes over time [weighted mean difference (95% CI): -0.01 mmol/L (-0.08, 0.06 mmol/L), 0.02 mmol/L (-0.05, 0.08 mmol/L), 0.03 mmol/L (-0.01, 0.07 mmol/L), and 0.04 mmol/L (-0.02, 0.10 mmol/L); -0.08 mm Hg (-0.26, 0.11 mm Hg); and -1.0 mm Hg (-2.4, 0.78 mm Hg) and 0.1 mm Hg (-1.2, 1.5 mm Hg) for TC, LDL cholesterol, HDL cholesterol, triglycerides, TC:HDL cholesterol, SBP, and DBP, respectively]. Among all subjects, TC, LDL cholesterol, HDL cholesterol, TC:HDL cholesterol, triglycerides, and DBP, but not SBP, decreased over time (P < 0.05).

CONCLUSIONS

The results from this systematically searched meta-analysis of RCTs support the idea that the consumption of ≥0.5 servings of total red meat/d does not influence blood lipids and lipoproteins or blood pressures.

Effects of dietary protein intake on body composition changes after weight loss in older adults: a systematic review and meta-analysis

CONTEXT

The impact of dietary protein on body composition changes after older adults purposefully lose weight requires systematic evaluation

OBJECTIVE

: This systematic review and meta-analysis assessed the effects of protein intake (< 25% vs ≥ 25% of energy intake or 1.0 g/kg/d) on energy restriction-induced changes in body mass, lean mass, and fat mass in adults older than 50 years.

DATA SOURCES

PubMed, Cochrane, Scopus, and Google Scholar were searched using the keywords "dietary proteins," "body composition," "skeletal muscle," and "muscle strength."

STUDY SELECTION

Two researchers independently screened 1542 abstracts.

DATA EXTRACTION

Information was extracted from 24 articles.

DATA SYNTHESIS

Twenty randomized control trials met the inclusion criteria.

CONCLUSION

Older adults retained more lean mass and lost more fat mass during weight loss when consuming higher protein diets.

Improving Milk Intake in Milk-Averse Lactose Digesters and Maldigesters

OBJECTIVE

To determine whether a 21-day milk-drinking intervention could reverse milk aversion.

DESIGN

Participants consumed increasing amounts of cow's milk for 21 days. Milk and dairy consumption, aversion, and likeness were assessed pre- and post-intervention and at 3 and 6 months post-intervention.

SETTING

A large Midwestern university.

PARTICIPANTS

Twenty-seven milk-averse individuals completed the intervention, 26 completed the 3-month follow-up, and 24 completed the 6-month follow-up.

MAIN OUTCOMES MEASURED

Participants self-reported milk and dairy consumption, aversion, and degree to which they liked milk.

ANALYSIS

Analysis of variance determined between-subject effects. Independent samples t test determined the effect of time. Fisher exact test determined factors affecting milk consumption.

RESULTS

Lactose digesters and maldigesters showed a significant decrease in overall symptom scores after the milk intervention, with no significant difference between groups. Independent of digestive status, subjects demonstrated a significant decrease in aversion, an increase in the amount to which they liked milk, and an increase in milk and overall calcium consumption at 3 and 6 months post-intervention.

CONCLUSIONS AND IMPLICATIONS

The results suggest a reversal of milk avoidance and the possibility that milk avoiders can increase likeness and incorporate milk into their diet after exposure.

Exercise patterns, ingestive behaviors, and energy balance

Ingestive and exercise behaviors are important determinants of whole body energy balance and weight control. An acute bout of exercise generates a transient energy deficit, which is only partially compensated for by food intake at the next eating occasion or within the next day (loose dietary coupling). Such an energy deficit, when repeated chronically, leads to moderate weight loss and improved body composition. For this narrative review, we assessed the effects of exercise patterns on energy intake, energy balance, and weight control in adults primarily using results from randomized acute exercise and chronic training studies. The patterns assessed were exercise mode (e.g. resistance, aerobic exercise), intensity, duration, time of day, and frequency. The body of evidence indicates that exercise training frequency and quantity are influential for weight loss. Aerobic training is superior to resistance training for weight loss, although resistance training helps preserve lean body mass better. Weight loss does not differ among different intensities when energy expenditure is matched by adjusting duration. Differing patterns of physical activity exhibited by normal weight, overweight, and obese people during weekdays and weekend days are consistent with their weight status; leaner people are more physically active. Collectively, these findings support acute and chronic exercise patterns as important modifiable behaviors to improve energy balance and weight control in adults while having minor effects on absolute energy intake.

Mobile MyPlate: a pilot study using text messaging to provide nutrition education and promote better dietary choices in college students

OBJECTIVE

To evaluate the acceptance and effectiveness of repetitive nutrition-related text messages on college students' nutrition knowledge and fruit and vegetable consumption.

PARTICIPANTS

One hundred fifty undergraduate (18-24 years old) non-health major students with a texting mobile phone.

METHODS

The intervention group received biweekly text messages of the MyPlate icon and the United States Department of Agriculture's Dietary Guidelines (DGs) for 7 weeks. The control group received the same information in a mailed brochure. A pre and post online survey assessed the students' knowledge and behavior.

RESULTS

The intervention resulted in greater MyPlate food group recognition (p <.05) compared with control and a trend toward improved knowledge of the DGs. In the intervention group, fruit consumption was elevated (p <.05) and a trend toward elevated vegetable consumption was determined. No gender differences in intervention effectiveness exist.

CONCLUSION

Texting repeated messages appears to be an acceptable and effective way to increase nutrition knowledge and promote positive diet-related behaviors in college students.

Diet-induced weight loss: the effect of dietary protein on bone

High-protein (>30% of energy from protein or >1.2 g/kg/day) and moderately high-protein (22% to 29% of energy from protein or 1.0 to 1.2 g/kg/day) diets are popular for weight loss, but the effect of dietary protein on bone during weight loss is not well understood. Protein may help preserve bone mass during weight loss by stimulating insulin-like growth factor 1, a potent bone anabolism stimulator, and increasing intestinal calcium absorption. Protein-induced acidity is considered to have minimal effect on bone resorption in adults with normal kidney function. Both the quantity and predominant source of protein influence changes in bone with diet-induced weight loss. Higher-protein, high-dairy diets may help attenuate bone loss during weight loss.

Reductive transformation of methyl parathion by the cyanobacterium Anabaena sp. strain PCC7120

Organophosphorus compounds are toxic chemicals that are applied worldwide as household pesticides and for crop protection, and they are stockpiled for chemical warfare. As a result, they are routinely detected in air and water. Methods and routes of biodegradation of these compounds are being sought. We report that under aerobic, photosynthetic conditions, the cyanobacterium Anabaena sp. transformed methyl parathion first to o,o-dimethyl o-p-nitrosophenyl thiophosphate and then to o,o-dimethyl o-p-aminophenyl thiophosphate by reducing the nitro group. The process of methyl parathion transformation occurred in the light, but not in the dark. Methyl parathion was toxic to cyanobacteria in the dark but did not affect their viability in the light. Methyl parathion transformation was not affected by mutations in the genes involved in nitrate reduction in cyanobacteria.

Survivor guilt, submissive behaviour and evolutionary theory: the down-side of winning in social comparison

In prior research submissive behaviour has been studied in relation to social comparison. Evolutionary theory conceptualized submissive behaviour as a fear-based self-protective strategy when in a subordinate position. In this study we hypothesized that survivor guilt, the type of guilt associated with feeling better off than others, is also linked to submissive behaviour. The Interpersonal Guilt Questionnaire, the Submissive Behaviour Inventory, the Eysenck Personality Questionnaire-Revised and the Automatic Thoughts Questionnaire were administered to a sample of 199 college students. Submissive behaviour was found to be significantly correlated with survivor guilt. Introversion, used as an indirect measure of the fear of being put down, was also correlated with submissive behaviour. A principal components analysis found two components: the first was composed of high loadings of submissiveness, survivor guilt and omnipotent responsibility guilt; the second was composed of high loadings of submissiveness and introversion. This supports the hypothesis that there may be two motivational states related to submissive behaviour, the fear of harm to the self, as described in prior studies, and the fear of harm to another or guilt-based submissive behaviour. We propose that survivor guilt has been selected by evolution as a psychological mechanism supporting group living, and that it may be considered from the perspective of inclusive fitness, reciprocal altruism, and multilevel selection theory.

Interpersonal guilt: the development of a new measure

We describe the development of a new measure to assess guilt related to concern about harming others. The two versions of the Interpersonal Guilt Questionnaire, a 45-item and 67-item version, include theoretically-based and clinically relevant categories of guilt: survivor guilt, separation/disloyalty guilt, omnipotent responsibility guilt, and self-hate guilt. Preliminary reliability and validity studies for both versions are presented, based on clinical and nonclinical samples of subjects. Subscales on both versions show good internal consistency; however, the second version, which expanded on the first, is more psychometrically sound overall. Both versions demonstrated predicted correlations with previously published measures of guilt and related affects, such as shame and depression, and with attributional style. Differences between clinical and nonclinical samples are reported and the relevance of survivor guilt and shame to psychopathology is noted.

Guilt, shame, and depression in clients in recovery from addiction

Men and women in recovery from addiction were compared on levels of depression, guilt, and shame. The measurement of guilt included subscales of Survivor Guilt, Separation Guilt, Omnipotent Responsibility Guilt, Trait Guilt, State Guilt, and Adaptive Guilt. The sample included 75 men and 33 women in treatment in a residential treatment community. It was found that women were significantly higher than men in depression. The recovering subjects were compared to nonaddicted subjects and established norms, and it was found that the recovering people were higher on depression, shame, and the subscales of maladaptive guilt. Both men and women in recovery were significantly lower than norms in adaptive guilt.

The drug-of-choice phenomenon psychological differences among drug users who preferred different drugs

The Eysenck Personality Questionnaire, the Sensation Seeking Scale, and the Brief Symptom Inventory were administered to 125 recovering drug users with three or more months abstinent from drugs. Subjects were divided according to drug preference: opiates, stimulants, marijuana, alcohol, and a polydrug preference. Opiate users were significantly higher in Susceptibility to Boredom. Alcohol misusers compared to a combined stimulant, opiate, and polydrug group were significantly lower in Extroversion and Susceptibility to Boredom. Subjects raised in drug/alcohol-using families scored significantly higher on Neuroticism and on the Positive Symptom Total of the BSI, and had a higher rate of suicidality.

Shame, guilt, and depression in men and women in recovery from addiction

Men and women in recovery from addiction were compared on levels of depression and self-conscious affect including proneness to shame, guilt, externalization, detachment, and pride. The sample consisted of 130 subjects (88 men and 42 women; mean age 33.04), 90 of whom were active participants in a 12-step recovery program, and 40 of whom were in a residential treatment community. Subjects completed The Beck Depression Inventory and The Test of Self-Conscious Affect. Significant differences between the sexes were found for proneness to shame, detachment, and depression. Women were significantly higher on shame and depression; men were significantly higher on detachment. The subjects were compared to subjects who were not chemically dependent. It was found that these recovering drug-addicted subjects scored significantly higher in proneness to shame and externalization and significantly lower on proneness to guilt. Treatment implications of proneness to shame in the drug-addicted population, and particularly in women, are discussed. The use of confrontational drug treatment strategies may be contraindicated.

Individual psychotherapy for addicted clients: an application of control mastery theory

This article presents an overview of Control Mastery Theory, developed by Joseph Weiss, and applies this theory to the treatment of alcohol- and other drug-addicted clients. The article proposes that individual psychotherapy, in conjunction with self-help and other chemical dependency treatment programs, may be a significant component of the treatment of addicted clients. According to Weiss's theory, addicted clients are suffering not only from the direct effects of addictive disease but are also often suffering from unconscious pathogenic beliefs acquired from childhood experiences. Pathogenic beliefs result in shame, guilt, fear, and inhibitions that predate the development of addiction. Addicted clients are highly motivated unconsciously to recover from their addiction and to pursue normal goals. They are hindered by their pathogenic beliefs and by the effects of their addiction. They enter treatment with an unconscious plan to stop using drugs and to disprove their pathogenic beliefs. They test their pathogenic beliefs in relation to the therapist, with the hope of obtaining evidence against these beliefs. As the therapist passes the client's tests, these beliefs are modified and the client is helped to recover.

Systemic sarcoidosis presenting initially with bilateral orbital and upper lid masses

A patient with systemic sarcoidosis presented initially with bilateral orbital and upper lid masses. Computed tomographic scan showed bilateral anterior orbital and upper lid masses, diffuse irregular thickening of the rectus muscles, circumferential cuffing of both globes, and irregular thickening of the distal portion of the right optic nerve sheath. A biopsy specimen of the right upper lid mass showed fibroadipose tissue with multiple noncaseating granulomas. Bilateral pulmonary hilar lymphadenopathy, a positive gallium scan, anergy by skin testing, and the presence of erythema nodosum confirmed the diagnosis of systemic sarcoidosis.