Higher rates of autism and attention deficit/hyperactivity disorder in American children: Are food quality issues impacting epigenetic inheritance?

In the United States, schools offer special education services to children who are diagnosed with a learning or neurodevelopmental disorder and have difficulty meeting their learning goals. Pediatricians may play a key role in helping children access special education services. The number of children ages 6-21 in the United States receiving special education services increased 10.4% from 2006 to 2021. Children receiving special education services under the autism category increased 242% during the same period. The demand for special education services for children under the developmental delay and other health impaired categories increased by 184% and 83% respectively. Although student enrollment in American schools has remained stable since 2006, the percentage distribution of children receiving special education services nearly tripled for the autism category and quadrupled for the developmental delay category by 2021. Allowable heavy metal residues remain persistent in the American food supply due to food ingredient manufacturing processes. Numerous clinical trial data indicate heavy metal exposures and poor diet are the primary epigenetic factors responsible for the autism and attention deficit hyperactivity disorder epidemics. Dietary heavy metal exposures, especially inorganic mercury and lead may impact gene behavior across generations. In 2021, the United States Congress found heavy metal residues problematic in the American food supply but took no legislative action. Mandatory health warning labels on select foods may be the only way to reduce dietary heavy metal exposures and improve child learning across generations.

FOOD AND SUPPLEMENT COMBINATIONS TO PREVENT OR POSTPONE AGING, MCI, AND ALZHEIMER’S DISEASE

Evidence of many interacting causes of aging has renewed interest in food and nutrient combinations that may blunt the main causes[PMC9184560, PMC8889622] and postpone aging, mild cognitive impairment and Alzheimer’s (“A-MCI-Alz”) in contrast to prior failures[PMC9232186]. We present an updated list of anti-aging/pro-longevity strategies to address limitations of previous food/nutrient combinations. Our list has two unusual features: (i) all interventions should be administered concurrently so no fundamental causes of A-MCI-Alz are without remediation and can inflame and leave smoldering important causal factors, (ii) all interventions should be provided daily or weekly to help avoid re-ignition of key factors driving A-MCI-Alz. These two features can help explain past longevity-trial failures[PMC9310407]: no previous study to our knowledge has included most or all of the following interventions, so untreated causes of A-MCI-Alz likely remained active[PMC9114803]. Our recommended interventions include intermittent-or-continuous calorie restriction or fasting[PMID: 33138875, PMC9351392, PMC7956384], protein- and/or methionine-restriction[PMC9197402, PMC4023024, PMC9197406], consumption of moderately-strong metal chelators (e.g. polyphenols in blueberries[PMC1413581], other berries[PMC8271923], grapes[PMC7096489, PMC6386230], cherries[PMC8745076], fruits with hesperidin/hesperitin [PMC9310407] like oranges, soybeans with genistein [PMC4286753], ginger [PMC5852742], ginseng [PMC9358063, PMC3830124, PMC6874434], green/rooibos/oolong teas[PMC6567241, PMIDs: 33285593, 19996359], coffee[PMC4926853, PMC9145055], chocolate[PMC9287426]), antioxidant-rich foods[PMC7530501], B vitamins including vitamin B5 (pantothenic acid[PMC9232186, PMC8725342, https://doi.org/10.3181%2F00379727-99-24442]) to help metabolize partly-toxic aldehydes[PMC6802361] and improve/lower lactate/pyruvate and NAD+/NADH ratios[PMC7346061], ingesting adequate-to-high amounts of longevity-correlated tyrosine[PMC6681387], cysteine[PMID: 20191258], glutathione[PMC8912885, PMC5005830], niacin, nicotine acid and/or NADH[PMC7346061, PMC6982340], spermidine[PMC8436989], anti-inflammatory NSAIDS[PMC4270464], autophagy inducers[PMC6191153] fiber[PMC8705837] and fluids[PMID: 21585170] to help remove excess metals, toxic metabolites and damaged organelles, while limiting methionine-rich, other pro-aging foods[PMC4023024].

Differences in health behaviors related to overweight/obesity by race/ethnicity in a diverse urban commuter college

Objective: To examine health behaviors associated with overweight/obesity by race/ethnicity at a diverse urban college. Participants: 270 undergraduates (77.0% female; 26.7% non-Hispanic white) and median body mass index (BMI) of 23.1 kg/m². Methods: A questionnaire about health-related behaviors as part of the "Get Fruved" project was used to measure health behaviors (sugar sweetened beverage (SSB), fruit and vegetable consumption, physical activity, stress, and sleep) by race/ethnicity. Multivariable logistic regression was used to assess the adjusted odds of engaging in positive health-related behaviors. Results: Non-Hispanic black and Hispanic students were 64% and 59% less likely to consume lower amounts of SSB. Hispanic students were 83% and 81% less likely to meet vegetable and fruit recommendations. Non-Hispanic black and other (including biracial) had reduced odds of meeting vegetable recommendations (AOR = 0.18 and 0.28). Conclusions: Disparities in SSB, fruit, and vegetable consumption represent potential intervention targets to improve health behaviors among racial/ethnic minorities.

Blood inorganic mercury is directly associated with glucose levels in the human population and may be linked to processed food intake

Background:

The goals of the study were (1) to determine the impact of inorganic mercury exposure on glucose homeostasis; and (2) to evaluate the effectiveness of two community-based interventions in promoting dietary changes among American Indian college students to reduce risk factors for Type-2 Diabetes including fasting glucose, insulin, and mercury levels, weight, and body mass index.

Methods:

To accomplish goal one, the National Health and Nutrition Examination Survey (NHANES) dataset was analyzed using a previously published method to determine if there is a relationship between inorganic blood mercury and fasting glucose. To accomplish goal two, ten college students were recruited and randomly assigned to a group receiving the online macroepigenetics nutrition course and the support group for eliminating corn sweeteners. Participants in both groups were assessed for diet patterns, weight, body mass index (BMI), fasting glucose, insulin, and mercury levels. The interventions were implemented over a 10-week period.

Results:

Analysis of the NHANES data (n=16,232) determined a direct relationship between inorganic mercury in blood and fasting glucose levels (p<0.001). The participants who took the online macroepigenetics nutrition intervention course significantly improved their diets (p<0.01), and fasting blood glucose levels (p<0.01) while having lower levels of inorganic mercury in their blood compared to the subjects in the group who eliminated corn sweeteners from their diet and participated in the support group. The trend in lower blood inorganic mercury was strong with p=0.052. The participants in the support group who eliminated corn sweeteners from their diet achieved significant weight loss (p<0.01) and reduced their body mass index (p<0.01).

Conclusion:

Total blood mercury levels may be influenced by dietary intake of highly processed foods and lower inorganic mercury levels are associated with lower fasting glucose levels. Alternative community-based interventions emphasizing the role food ingredients and toxic substances play in gene modulation and the development of diseases can result in significant dietary improvements and reductions in risk factors associated with type-2 diabetes. A healthier diet can be promoted among community members using a novel online nutrition course. Consumption of corn sweeteners may be a risk factor in the development of obesity.

A macroepigenetic approach to identify factors responsible for the autism epidemic in the United States

The number of children ages 6 to 21 in the United States receiving special education services under the autism disability category increased 91% between 2005 to 2010 while the number of children receiving special education services overall declined by 5%. The demand for special education services continues to rise in disability categories associated with pervasive developmental disorders. Neurodevelopment can be adversely impacted when gene expression is altered by dietary transcription factors, such as zinc insufficiency or deficiency, or by exposure to toxic substances found in our environment, such as mercury or organophosphate pesticides. Gene expression patterns differ geographically between populations and within populations. Gene variants of paraoxonase-1 are associated with autism in North America, but not in Italy, indicating regional specificity in gene-environment interactions. In the current review, we utilize a novel macroepigenetic approach to compare variations in diet and toxic substance exposure between these two geographical populations to determine the likely factors responsible for the autism epidemic in the United States.

Mercury exposure, nutritional deficiencies and metabolic disruptions may affect learning in children

Among dietary factors, learning and behavior are influenced not only by nutrients, but also by exposure to toxic food contaminants such as mercury that can disrupt metabolic processes and alter neuronal plasticity. Neurons lacking in plasticity are a factor in neurodevelopmental disorders such as autism and mental retardation. Essential nutrients help maintain normal neuronal plasticity. Nutritional deficiencies, including deficiencies in the long chain polyunsaturated fatty acids eicosapentaenoic acid and docosahexaenoic acid, the amino acid methionine, and the trace minerals zinc and selenium, have been shown to influence neuronal function and produce defects in neuronal plasticity, as well as impact behavior in children with attention deficit hyperactivity disorder. Nutritional deficiencies and mercury exposure have been shown to alter neuronal function and increase oxidative stress among children with autism. These dietary factors may be directly related to the development of behavior disorders and learning disabilities. Mercury, either individually or in concert with other factors, may be harmful if ingested in above average amounts or by sensitive individuals. High fructose corn syrup has been shown to contain trace amounts of mercury as a result of some manufacturing processes, and its consumption can also lead to zinc loss. Consumption of certain artificial food color additives has also been shown to lead to zinc deficiency. Dietary zinc is essential for maintaining the metabolic processes required for mercury elimination. Since high fructose corn syrup and artificial food color additives are common ingredients in many foodstuffs, their consumption should be considered in those individuals with nutritional deficits such as zinc deficiency or who are allergic or sensitive to the effects of mercury or unable to effectively metabolize and eliminate it from the body.

Mercury from chlor-alkali plants: measured concentrations in food product sugar

Mercury cell chlor-alkali products are used to produce thousands of other products including food ingredients such as citric acid, sodium benzoate, and high fructose corn syrup. High fructose corn syrup is used in food products to enhance shelf life. A pilot study was conducted to determine if high fructose corn syrup contains mercury, a toxic metal historically used as an anti-microbial. High fructose corn syrup samples were collected from three different manufacturers and analyzed for total mercury. The samples were found to contain levels of mercury ranging from below a detection limit of 0.005 to 0.570 micrograms mercury per gram of high fructose corn syrup. Average daily consumption of high fructose corn syrup is about 50 grams per person in the United States. With respect to total mercury exposure, it may be necessary to account for this source of mercury in the diet of children and sensitive populations.

Caffeinated beverage intake and the risk of heart disease mortality in the elderly: a prospective analysis

BACKGROUND

Motivated by the possibility that caffeine could ameliorate the effect of postprandial hypotension on a high risk of coronary events and mortality in aging, we hypothesized that caffeinated beverage consumption decreases the risk of cardiovascular disease (CVD) mortality in the elderly.

OBJECTIVE

The objective of the study was to use prospective cohort study data to test whether the consumption of caffeinated beverages exhibits this protective effect.

DESIGN

Cox regression analyses were conducted for 426 CVD deaths that occurred during an 8.8-y follow-up in the prospective first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. The analysis involved 6594 participants aged 32-86 y with no history of CVD at baseline.

RESULTS

Participants aged >or=65 y with higher caffeinated beverage intake exhibited lower relative risk of CVD and heart disease mortality than did participants with lower caffeinated beverage intake. It was a dose-response protective effect: the relative risk (95% CI) for heart disease mortality was 1.00 (referent), 0.77 (0.54, 1.10), 0.68 (0.49, 0.94), and 0.47 (0.32, 0.69) for <0.5, 0.5-2, 2-4, and >or=4 servings/d, respectively (P for trend = 0.003). A similar protective effect was found for caffeine intake in mg/d. The protective effective was found only in participants who were not severely hypertensive. No significant protective effect was found in participants aged <65 y or in cerebrovascular disease mortality for those aged >or=65 y.

CONCLUSION

Habitual intake of caffeinated beverages provided protection against the risk of heart disease mortality among elderly participants in this prospective epidemiologic analysis.

Coffee, tea and diabetes: the role of weight loss and caffeine

OBJECTIVE

To assess the effect of weight change on the relationship between coffee and tea consumption and diabetes risk.

DESIGN

Prospective cohort study, using data from the First National Health and Nutrition Examination Survey Epidemiologic Follow Up Study. Survival analyses were conducted using 301 selfreported cases of diabetes and eight documented diabetes deaths during an 8.4-y follow-up.

SUBJECTS

A total of 7006 subjects aged 32-88 y with no reported history of diabetes were included in the study.

RESULTS

For all subjects combined, increases in consumption of ground-caffeinated coffee and caffeine at baseline were followed by decreases in diabetes risk during follow-up. There were significant statistical interactions between age and consumption of caffeine (P=0.02) and ground-caffeinated coffee (P=0.03). Age-stratified analysis showed that the decrease in diabetes risk only applied to < or =60-y-old subjects, for whom the decrease in diabetes risk also obtained for ground-decaffeinated coffee and regular tea. The multivariate hazard ratio (HR) and 95% confidence interval for a 2 cups/day increment in the intake of ground-caffeinated coffee, ground-decaffeinated coffee and regular tea was 0.86 (0.75-0.99), 0.58 (0.34-0.99) and 0.77 (0.59-1.00), respectively. The diabetes risk was negatively related to the consumption in a dose-response manner. There were strong statistical interactions between prior weight change and beverage consumption for < or =60-y-old subjects. Further analysis revealed that the decrease in diabetes risk only applied to those who had lost weight, and that there was a positive dose-response relationship between diabetes risk and weight change. For example, the multivariate HR and 95% confidence interval for >0 vs 0 cups/day of ground-decaffeinated coffee was 0.17 (0.04-0.74), 0.52 (0.19-1.42), 0.77 (0.30-1.96) and 0.91 (0.39-2.14) for subgroups with weight change of < or =0, 0-10, 10-20 and >20 lbs, respectively. There was no significant association between diabetes risk and consumption of instant-caffeinated coffee, instant-decaffeinated coffee or herbal tea. Caffeine intake appeared to explain some, but not all, of the diabetes-risk reduction and weight change.

CONCLUSION

The negative relationship between diabetes risk and consumption of ground coffee and regular tea, observed for all NHEFS subjects, actually only applied to nonelderly adults who had previously lost weight.

Nutrition in the treatment of attention-deficit hyperactivity disorder: a neglected but important aspect

Attention-deficit hyperactivity disorder (ADHD) is multidetermined and complex, requiring a multifaceted treatment approach. Nutritional management is one aspect that has been relatively neglected to date. Nutritional factors such as food additives, refined sugars, food sensitivities/allergies, and fatty acid deficiencies have all been linked to ADHD. There is increasing evidence that many children with behavioral problems are sensitive to one or more food components that can negatively impact their behavior. Individual response is an important factor for determining the proper approach in treating children with ADHD. In general, diet modification plays a major role in the management of ADHD and should be considered as part of the treatment protocol.

Self-regulation training enhances dietary self-efficacy and dietary fiber consumption

OBJECTIVE

To evaluate the effectiveness of incorporating two self-regulation strategies (goal setting and self-monitoring) into a nutrition education class to enhance dietary fiber self-efficacy and foster a positive change in dietary fiber consumption.

DESIGN

College students in an introductory nutrition class (n = 113) were randomly assigned to one of four treatment conditions: goal setting, self-monitoring, goal setting and self-monitoring, and no goal setting and no self-monitoring. Twenty-six college students from an introductory health class served as the control group.

STATISTICAL ANALYSES

The main and interaction effects of goal setting and self-monitoring on postintervention variables were analyzed using analysis of covariance with baseline intake levels as the covariate. Analysis of variance was used to examine differences in the mean changes between the groups. Path analysis was conducted to analyze the causal linkage among the pretest and intervening variables to predict postintervention knowledge, self-efficacy, and fiber consumption.

RESULTS

Goal setting had a significant main effect on dietary fiber self-efficacy and on dietary fiber consumption Subjects who set goals scored 15% higher on the dietary fiber self-efficacy scale and consumed 91% more fiber than subjects who did not set goals. Self-monitoring had no significant main effect on either dietary fiber self-efficacy or dietary fiber consumption. There was no significant interaction between goal setting and self-monitoring. Changes in dietary fiber scores differed between the groups. Increases in dietary fiber for the goal setting and self-monitoring group were significantly higher than the goal-setting, self-monitoring, no goal setting and no self-monitoring, and control groups. In addition, the goal setting only group had significantly greater increases in fiber intake than the self-monitoring, no goal setting and no self-monitoring, and control groups. Changes in self-efficacy scores were significantly different between the groups. The goal setting and goal setting and self-monitoring groups had significantly higher self-efficacy scores than the control group. Path analysis revealed that both goal setting and self-monitoring affected dietary fiber consumption through knowledge and dietary fiber self-efficacy, goal setting had a strong direct effect on fiber consumption, and postintervention knowledge affected fiber consumption only through self-efficacy.

APPLICATIONS/CONCLUSIONS

Our findings suggest that dietary change requires active self-regulation of food intake. Combining goal setting and self-monitoring significantly enhances dietary behavior change. This strategy can easily be incorporated into nutrition education or counseling programs to enhance dietary behavior change.

Measuring supportive and unsupportive responses during cancer treatment: a factor analytic assessment of the partner responses to cancer inventory

This study examined the psychometric structure of a measure of positive and negative spouse responses to individuals with cancer, the Partner Responses to Cancer Inventory (PRCI). The forty-eight items were either developed by the authors or adapted from the Inventory of Socially Supportive Behaviors. Seven a priori subscales of the PRCI, four positive support scales and three negative spouse behavior scales, were hypothesized. The instrument was administered to 304 cancer patients undergoing cancer treatment. Exploratory factor analyses yielded four factors that were subsequently confirmed by confirmatory factor analysis: (a) Emotional and Instrumental Support, (b) Cognitive Information and Guidance, (c) Encouraging Distancing and Self-Restraint, and (d) Criticism and Withdrawal. The measure satisfied standard criteria for internal consistency and construct validity, and thus may be useful for social support theory and research.

Measuring cancer patients' psychological distress and well-being: a factor analytic assessment of the Mental Health Inventory

This study examined the psychometric structure of the Mental Health Inventory (MHI) in 433 cancer patients. Using structural equation modeling, confirmatory factor analyses (CFAs) were conducted. Next, exploratory factor analysis (EFA) was used to explore an alternative MHI factor structure with a randomly chosen subsample. Finally, CFAs were conducted on 6 MHI models with the second subsample. Convergent validity was examined by administering the Positive and Negative Affect Schedule (PANAS) and the Dyadic Adjustment Scale (DAS). The CFAs with the original MHI factor structure indicated inadequate fit, supporting the need to conduct an EFA. Results of the EFA indicated support for a 5-factor solution but numerous differences in item factor loadings. The CFA indicated that the 5-factor correlated model was the best fitting model. Correlations between the PANAS and the DAS with the MHI provided preliminary support for the convergent validity of the MHI. Together, these results indicate that the original MHI factor structure may require modification for use in patients with cancer.

Women HIV sexual risk takers: related behaviors, interpersonal issues, and attitudes

HIV and AIDS is a growing health risk for heterosexual women, particularly women of color (Centers for Disease Control and Prevention, 1997). Our research identified 5 types of HIV sexual risk taking in 3 independent samples of adult women from a New England Community: Group A women were noted by low to moderate levels of the 4 risk markers (i.e., unprotected vaginal sex, perceived partner-related risk, number of sexual partners, and unprotected anal sex); Group B women reported very high frequency of unprotected vaginal sex; Group C women were characterized by unprotected anal sex; Group D women had high perceived partner risk; and Group E women reported extremely high levels on all 4 HIV risk markers. Sexual risk groups were validated by demonstrating significant differences among groups on relevant behaviors, interpersonal experiences, and attitudes. Compared to other women, higher risk types reported greater behavioral risk practices (substance use, prostitution, diverse sexual experience), interpersonal risk experiences (sexual abuse, violence), initiation sexual assertiveness, and attitudinal risks (psychosocial distress). They reported less interpersonal assurance (surety of own and partner's HIV status), sexual assertiveness (for condom use and partner communication), psychosocial strengths (sexual self-acceptance), and transtheoretical readiness for change (condom use efficacy, readiness to consider condoms). Results provide additional support for the multifaceted model of HIV risk and the transtheoretical model. Suggestions for specifically focused interventions are given, depending on the pattern of sexual risk taking.

Using two factor structures of the Mental Adjustment to Cancer (MAC) scale for assessing adaptation to breast cancer

The validity and reliability of two factor structures of the Mental Adjustment to Cancer (MAC) scale for assessing coping style was assessed by examining the relationship between the subscales, psychological distress, and quality of life (QOL) among Stage II and Stage IV breast cancer patients in four phases. First, MANOVAs assessed differences in coping, distress, and QOL across disease stages. Second, for each MAC factor structure, canonical correlation analyses assessed the relationship between coping styles, distress, and QOL, for each disease-stage group separately. Third, structural equation modeling (SEM) assessed the relationship among coping styles, distress, and QOL for all participants. Finally, the internal consistency of both MAC factor structures was assessed using Chronbach's alpha. The results were as follows: (1) significant differences across disease stages were found for coping styles using either the Watson or the Schwartz MAC subscales, but there were no differences in levels of distress or QOL; (2) for both MAC factor structures, coping style was found to be highly related to emotional distress and QOL, however, the strengths of the correlations between individual coping styles and distress/QOL indicators varied across disease stages; (3) SEM indicated that coping style was significantly related to distress and QOL when stage of disease was not considered, and that coping style and indicators of distress/QOL are separate, but highly correlated factors, as opposed to a single latent construct; and, (4) the Watson MAC subscales showed slightly better internal consistency than the Schwartz MAC subscales. Taken together, these findings highlight: (i) the validity of both MAC factor structures for clinical and research use with American breast cancer patients; (ii) the role of coping style as a mediator between disease stage and psychological distress and QOL; and, (iii) the need for refinement of certain Watson and Schwartz subscales.