Journal of the Academy of Nutrition and Dietetics最新文献

Background: Objective methods are needed to assess adolescent fruit and vegetable (FV) intake to better evaluate interventions aimed at improving FV intake. Skin carotenoid concentration measures provide a potential objective biomarker of FV intake, but the plausibility and robustness must be established across adolescent populations.

Objective: The objective of this study is to evaluate the relationship between pressure-mediated reflection spectroscopy-measured skin carotenoid scores (SCSs) and self-reported FV intake frequency among US racial and ethnic minority adolescents in Houston, TX.

Design: This is a secondary analysis of data collected on adolescents participating in the randomized, controlled study "Teens Committed to Health Through Activity, Relationships, and Good Eating (Take CHARGE!)."

Participants/setting: Participants were Hispanic (86.2%), African American (12.6%), and Asian (1.2%) adolescents (10-17 years of age) (N=167) who participated in a year-long healthy lifestyles program as their physical education class in Houston, TX from August 2018 to 2019.

Main outcome measures: Over the course of a year, participants' SCSs were measured by pressure-mediated reflection spectroscopy and self-reported FV intake frequency was assessed using questions from the School Physical Activity and Nutrition questionnaire at four separate time points.

Statistical analysis: The relationship between adolescent SCSs and FV intake frequency was tested using generalized linear mixed models, controlling for BMI z-score, sex, time-point, group assignment, and age.

Results: SCSs were positively predicted by self-reported intake frequencies for FV (β=2.398, p=0.028), vegetables (β=3.870, p=0.010), and orange and dark green vegetables (β=5.274, p=0.019), with no significant relationship observed with fruit intake frequency (β=1.151, p=0.613).

Conclusion: Self-reported total FV (combined), vegetable, and orange and green vegetable (combined) intake frequency is a predictor of SCSs among racial and ethnic minority adolescents in Houston, TX. Skin carotenoid measurement merits further investigation as a biomarker of vegetable intake in US adolescents.

Background: Mindful eating, a practice that encourages attention to sensations and awareness during the eating experience, has shown effectiveness in inducing positive behavioral changes. Mindful eating practices have been examined in relation to energy intake (i.e., quantity of food) but to a lesser extent to the quality of that food, hence, it is crucial to comprehensively understand the association between mindful eating and diet quality.

Objective: The objective of this study is to examine the association between mindful eating and diet quality among United States (U.S.) adults with lower incomes and to examine heterogeneity in the associations by gender identity.

Design: This study employs a cross-sectional study design.

Participants/setting: In December 2022, a national convenience sample of 1,798 U.S. adults with lower incomes, recruited through Prime Panels, completed a web-based survey.

Main outcome measures: Diet quality was measured using the 30-day Prime Diet Quality Score screener (ranges from 0-126). A higher score reflects higher diet quality.

Statistical analyses performed: Associations between the Mindful Eating Questionnaire (MEQ) (ranges from 1-4) and its four factors (Awareness, External Cues, Emotional Response, and Distraction) in relation to diet quality were examined using multivariable regression models, adjusting for sociodemographic covariates.

Results: The mean MEQ score was 2.30; the mean PDQS-30D score was 50.2. The associations between MEQ scores and PDQS-30D scores were significantly modified by gender identity. Among men, a higher MEQ score reflecting more mindful eating (β=3.81, 95% CI: 2.19, 5.43) was associated with higher PDQS-30D scores. In addition, a higher Awareness factor score (β=3.21, 95% CI: 2.48, 3.93), a higher External Cues factor score indicating less response to external cues (β=0.76, 95% CI: 0.01, 1.52), and a higher Distraction factor score indicating less distraction (β=1.09, 95% CI: 0.28, 1.90) were all associated with higher PDQS-30D scores. Among women, a higher Awareness factor score was associated with higher PDQS-30D scores (β=2.50, 95% CI: 1.78, 3.22); and a higher Emotional response factor score (i.e., eating less in response to emotional eating) was associated with lower PDQS-30D scores (β=-0.85, 95% CI: -1.58, -0.12).

Conclusions: Mindful eating and its factors are associated with a higher diet quality among U.S. adults with lower incomes, particularly among men. Future longitudinal and intervention studies are warranted to better understand these associations among adults with lower incomes, as an understudied population in the mindful eating literature.

Background: Implications of life-long, perceived discrimination on nutrient intake during the preconception period are unclear.

Objective: The objective is to identify associations between perceived discrimination and consumption of specific nutrients associated with risk of adverse pregnancy outcomes.

Design: This is a secondary data analysis of the prospective Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (NuMom2b) cohort. Participants completed a Block Food Frequency Questionnaire assessing diet in the three months prior to pregnancy and a Krieger Experiences of Discrimination Scale assessing personal encounters of discrimination.

Participants/setting: Participants were recruited from eight clinical centers across the US between 2010-2013. Each participant completed the Food Frequency and Krieger questionnaires and self-identified as belonging to a minoritized racial or ethnic group for this analysis (n=2457).

Main outcome measures: Main outcomes include reported total energy and macronutrient intake, percent of energy from macronutrients, saturated and unsaturated fatty acids (FA), added sugar, sodium, dietary fiber, and Healthy Eating Index-2010 Seafood and Plant Proteins component score.

Statistical analyses performed: Participants were grouped as reporting fewer (<3) or more (≥3) circumstances of discrimination on the Krieger Scale. Multivariable regression models examined associations between discrimination group and nutrient intake. Variables with non-normal distributions were log transformed. Associations were adjusted for total energy intake. Primary outcomes underwent false discovery rate correction (FDR).

Results: Those reporting three or more circumstances of discrimination had higher reported energy intake (p=0.002) and higher reported intake of total fat, saturated fat, unsaturated fats, protein, added sugar and sodium after FDR (all p<0.05) as compared to those reporting fewer circumstances. After adjustment for total energy intake, reporting three or more circumstances was associated with greater reported intake of saturated fat and n-3 polyunsaturated FA, and lower reported intake of dietary fiber (all p<0.05).

Conclusion: Reporting three or more circumstances of discrimination was associated with higher reported total energy intake. After adjustment for total energy, reporting three or more circumstances of perceived discrimination was associated with less nutritious intake for some (higher saturated fat and lower dietary fiber) but not all (higher eicosapentaenoic and docosahexaenoic acids) nutrients.

Background: Universal school meals (USM) aim to eliminate barriers to school meal access by providing free meals to all students regardless of family income. During the COVID-19 pandemic, United States Department of Agriculture waivers allowed schools nationwide to offer meals free of charge to all students. While USM programs have demonstrated positive effects on student health and participation, limited research has focused on the perspectives of Food Service Directors (FSD) who manage them.

Objective: The study aims to explore the operational benefits and challenges encountered by FSDs, and their perceptions of the benefits of USM for students and parents during the implementation of USM during the 2021-22 school year.

Design: Qualitative using semi-structured interviews.

Participants/setting: Twenty-nine California FSDs selected through purposive sampling to ensure diversity in district size, urbanicity, and student eligibility for free or reduced-price meals. Interviews were conducted via Zoom in Spring 2022.

Analysis: Thematic analysis using an immersion-crystallization approach.

Results: FSDs perceived multiple benefits of USM, including increased meal participation, reduced stigma around free meals, and strong support for USM from parents and school communities. They believed consistent access to meals improved learning readiness and behavior. Operationally, FSDs reported increased administrative efficiency and the elimination of student meal debt. However, higher meal demand led to increased workloads compounded by staffing shortages, challenges in hiring and retention, and supply issues exacerbated by the pandemic. California's Kitchen Infrastructure and Training grants supported equipment upgrades. Despite challenges, FSDs were optimistic about the future of USM and expressed a strong desire for its continuation.

Conclusions: FSDs perceived USM as beneficial for improving meal access, reducing stigma, and enhancing administrative efficiency. However, sustaining these benefits requires addressing operational challenges through targeted support and investments. Future research should assess the long-term viability of USM and strategies for overcoming challenges outside the pandemic context.

The emergence of incretin-based therapies, specifically glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and glucose-dependent insulinotropic polypeptide (GIP), as a new class of obesity medications, is dramatically changing obesity care. Use of these medications, known categorically as anti-obesity medications, as part of comprehensive obesity management is associated with significantly greater weight loss and health benefits than found with earlier generation obesity medications. The outcomes reported from medication trials were often achieved in conjunction with lifestyle counseling sessions by a registered dietitian nutritionist (RDN) or other qualified health care professional. Research demonstrates that evidence-based obesity care should incorporate lifestyle interventions. Counseling by a RDN, paired with incretin-based therapies, can play a critical role in supporting adherence to the medication regimen, preventing and managing side effects, adequate nutrient intake, and establishment of lifestyle behaviors for long-term weight and health management. To date, minimal research has been reported on the impact of incretin-based therapies on food and nutrient intake. Until that research is conducted, RDNs and other health professionals can apply knowledge and experience from clients who have undergone other intensive treatments. This article provides considerations for lifestyle interventions, with a focus on medical nutrition therapy (MNT) provided by RDNs, for adults prescribed incretin-based therapies. RDNs have the education and training to provide MNT for people with overweight or obesity, as well as lifestyle counseling on physical activity, stress management, sleep hygiene, goal setting, and other behaviors associated with positive health outcomes. RDNs have a critical role in the integration of incretin-based therapies into obesity management.

Background: Restricted carbohydrate diets remain among the most popular for weight loss and general health improvement. Recent evidence demonstrates that carbohydrate restricted diets are low in overall diet quality, yet their association with micronutrient inadequacy has not been well characterized at a population-level in adults in the United States.

Objective: 1) To evaluate the prevalence of not meeting daily micronutrient recommendations in US adults that met the Acceptable Macronutrient Distribution Ranges (AMDRs) and those who restricted carbohydrate to <45% energy, and 2) examine the effect of total fat and fat class on these results for the restricted carbohydrate group.

Design: This study utilized 24-hour recall data on food and nutrient intake from respondents in the National Health and Nutrition Examination Survey (NHANES) 2007-2018.

Participants/setting: This study included 15,029 respondents who were ≥20 y, had complete and reliable nutrient intake data, and were not pregnant or breastfeeding.

Main outcome measures: The main outcome was the prevalence of not meeting daily micronutrient recommendations based on Dietary Reference Intakes (DRIs).

Statistical analyses performed: The National Cancer Institute's usual intake methodology was used to estimate usual dietary intake and the prevalence of the US adult population not meeting the DRIs.

Results: Compared to participants that met the AMDRs, those that consumed restricted carbohydrate diets had greater prevalence of inadequacy (%

Conclusion: This study shows that there are different types of restricted carbohydrate diets that can be characterized by fat amount and class, each with their own association with micronutrient intake. This information can be used by clinicians to provide more targeted dietary counseling to their patients who restrict carbohydrates, depending on the amount and type of fat they consume.

Background: Malnutrition is prevalent across healthcare settings and has adverse outcomes for patients and the health system. However, some patients do not recall being informed about their malnutrition risk/diagnosis.

Objective: This meta-synthesis of qualitative studies aimed to identify and synthesise patient, carer and health worker perceptions and understanding of the terminology used by health workers for malnutrition risk/malnutrition.

Methods: Four databases were searched (Medline, CINAHL, PsycINFO and Embase) up until August 2023. Title, abstract and full text screening were independently completed by 2 reviewers. The quality of the included studies was assessed using the Critical Appraisal Skills Programme Qualitative Studies Checklist. Data were analysed by the review team using thematic synthesis. The resulting themes informed review findings. The confidence in each finding was assessed using GRADE-CERQual.

Results: Seventeen studies were included contributing perspectives from patients (n=7 studies), health workers (n=5 studies) or both patients and health workers (n=5 studies); no studies included carer perspectives. There were 5 themes: "Patients have differing understanding, interpretation of, and identification with malnutrition risk and malnutrition terminology" (very low confidence); "Health workers perceive that patients do not identify with or understand malnutrition risk and malnutrition terminology" (low confidence); "Patients do not routinely perceive their malnutrition risk or malnutrition diagnosis as problematic" (low confidence); "Health workers use varied terminology for malnutrition risk and malnutrition" (low confidence); "Action is required to improve malnutrition diagnostic communication" (low confidence).

Conclusions: Findings highlighted disparity in patients' perspectives regarding the terms used for malnutrition risk and malnutrition. Varied terms were used by health workers and patients did not often associate these terms with a health condition that required treatment. Health workers and patients called for action to improve the communication of malnutrition. To do this, further research exploring malnutrition terminology and the broader concept of malnutrition communication is required with patients, carers and health workers.

Background: Adequate water intake is associated with improved cognitive and physical performance, prevention of dental caries, and overweight and obesity. However, access to free drinking water in schools remains inadequate. Water First, a school-based intervention promoting water consumption, was shown effective in preventing overweight, yet its costs have not been quantified.

Objective: To evaluate the costs of Water First from the school's perspective over one academic year.

Design: Secondary analysis of a cluster-randomized clinical trial assessing the cost of Water First.

Participants/setting: Six public schools in the San Francisco Bay Area in the 2018-2019 academic year, with an average of 578±69 students per school and 110±2 fourth-grade students in intervention schools, and 508±190 students per school and 101±5 fourth-grade students in control schools.

Intervention: Schools were randomized to receive water dispensers and stations in cafeterias and high-traffic areas and a schoolwide water promotion campaign (school-level intervention). Fourth-grade students and teachers received reusable water bottles, lessons, and materials for school and home (class-level intervention).

Main outcome measures: Activities, resources, and the value needed to implement the school- and classroom-level intervention were systematically captured over one academic year, including labor, materials, and utilities costs.

Statistical analysis: The intervention costs per school and per student were estimated by summing the component-specific costs. Results are presented for both school- and classroom-level interventions in 2023 USD.

Results: The Water First intervention costs $20 per student for the school- and $131 per student for the classroom-level intervention over one academic year. Accounting for the useful life of the installed water stations and dispensers beyond one year, the annualized cost of the school-level intervention was $11 per student.

Conclusions: These cost estimates provide useful insights for schools and stakeholders to plan and implement effective school-based interventions that promote access to drinking water.