Journal of the Academy of Nutrition and Dietetics最新文献

Introduction: Children's consumption of ultra-processed food (UPF) may contribute to inequalities in obesity and wider health. Socioeconomic patterning in younger UK children's UPF intake is unknown.

Objective: To investigate socioeconomic patterning of UK toddlers' (21-months) and children's (7-years) UPF intake across several household and neighbourhood indicators.

Design: Secondary analysis of data from a prospective longitudinal cohort study using parent-report sociodemographic data and 3-day diet diaries.

Participants: /setting: Participants were children from the UK Gemini study of n=4,804 twins born in 2007. At 21-months and 7-years, n=2,591 and n=592 children had at least 2-days of dietary data, respectively.

Main outcome measures: Percentage energy from UPF at 21-months and 7-years-of-age, classified using the NOVA system.

Statistical analyses performed: Unadjusted linear regression models were run for household socioeconomic position (SEP) composite score, Index of multiple deprivation decile, income, occupation level, mother's age, education of mother and partner, child's ethnicity, sex, and age. Adjusted multivariable linear regression models were adjusted for ethnicity and all SEP indicators except SEP composite score (Adjusted 1), in addition to child sex and age (Adjusted 2). Missing data were addressed with multiple imputation and inverse probability weighting. Confidence intervals and P-values were adjusted to account for clustering within families.

Results: Children of lower SEP had higher UPF intake across several indicators. Mother's education was the strongest predictor, with postgraduate education associated with 8.64% (95% CI -12.08 to -5.20; P<0.001) and 10.12% (95% CI -15.68 to -4.56; P<0.001) less energy from UPF at 21-months and 7-years, respectively, compared to no educational qualifications in Adjusted model 2.

Conclusion: UK children from more disadvantaged backgrounds consumed a greater proportion of their energy from UPF. Mother's education seemed the most influential factor. Socioeconomic inequalities, particularly in maternal education, may drive disparities in diet quality and associated health outcomes. Addressing these gaps is essential to reduce childhood obesity and improve long-term health in socioeconomically disadvantaged populations.

Background: Home visitation programs are uniquely positioned to reach young children during the first 2000 days of life (ages 0 to 5 years), a critical time period to prevent childhood obesity.

Objective: This scoping review aimed to identify early childhood obesity prevention interventions implemented within home visitation during the first 2000 days of life, summarize outcomes assessed, and examine if and how nonmaternal caregivers and technology were included.

Methods: Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, three databases (PubMed, Web of Science, CINAHL) were searched from January 1980 to June 2023 for obesity prevention interventions that utilized home visitation as a treatment modality, targeted children ≤5 years old, reported on child weight outcomes, were experimental or quasi-experimental designs with a control or comparison arm, and had full-text available in English. The quality and risk of bias of included studies were rated using the Academy of Nutrition and Dietetics' Quality Criteria Checklist for Primary Research.

Results: Of the 871 identified articles, 21 met inclusion criteria, and all reported at least one obesogenic behavioral outcome in the intervention group compared to the control group. Intervention duration ranged from 4 months to 3 years, and frequency of home visits varied from weekly, biweekly, monthly, or a designated number of home visits within a defined time frame. Three interventions partnered with an established home visiting program, but home visits in all interventions were conducted by either professional or paraprofessional individuals. Nine of the 21 studies targeted other caregivers in addition to the mother and 12 of 21 incorporated a form of technology.

Conclusions: Several different early childhood obesity prevention interventions have been implemented within home visitation during the first 2000 days of life. Future research is needed to investigate the effectiveness of these interventions on weight- and behavioral-related outcomes, as well as explore the impacts of the interventionist type, program duration, inclusion of nonmaternal caregivers, and use of technology on childhood obesity-related outcomes.

Background: Though the Dietary Guidelines for Americans recommend that individuals drink water instead of sugar-sweetened beverages (SSBs), this behavior is influenced and reinforced by a complex network of structures and systems.

Objective: The objectives of this study were to develop a shared understanding among multiple stakeholders about the structural and underlying, interconnected drivers of SSB and water consumption in the Washington D.C. metro area and to have them identify feasible and impactful policy levers.

Design: A community-based system dynamics approach was used during a 2-day group model building workshop where stakeholders engaged to develop a shared visual representation of the underlying, interconnected drivers of SSB and water intake and to identify what they thought were impactful and feasible policy levers.

Participants/setting: Stakeholders were purposively recruited from diverse sectors (early childhood education (n=6), nutrition assistance programs (n=2), food policy council and advocacy groups (n=4), city government officials including municipal water (n=4), and food and beverage retail (n=1)) to participate in a group model building workshop in July of 2022 in Washington, D.C.

Analysis: Using member checking and iterative feedback, the research team synthesized the outputs from the workshop into one causal loop diagram and ranked policy levers.

Results: Stakeholders visualized 7 subsystems that drive water and SSB consumption, then identified and ranked 5 policy levers by potential impact and ease of implementation, including 1) increase public health spending (high impact/hard to do); 2) invest in new and updated infrastructure for public water (high impact/hard to do); 3) implement coordinated public health campaigns to promote drinking safe, palatable water as an alternative to SSB (low impact/easy to do); 4) provision of tap water filters (low impact/easy to do); and 5) limits on SSB marketing (high impact/debated easy-or-hard to do).

Conclusions: This participatory approach allowed stakeholders to envision multiple places to intervene in the system simultaneously to both decrease SSB and increase water consumption in the specific context of their community.

Background: Poor-quality diets are a major risk factor for noncommunicable diseases. Few studies in Mexico have tested whether higher expenditures are needed to purchase high-quality food.

Objective: The objective of the study was to assess how dietary quality of food purchases was associated with household food at home expenditures.

Design: This study was a secondary analysis of cross-sectional data from the National Household Income and Expenditure Survey (EncuestaNacional de Ingresos y Gastos de los Hogares [ENIGH] 2018).

Participants/setting: The study included 74 469 households with information on food and beverage purchases in Mexico in 2018.

Main outcome measures: Quarterly household food at home expenditures by adult equivalent (AE) for all food groups that were scored with the Global Dietary Quality Score (GDQS) for food purchases expressed in dollars/quarterly/AE.

Statistical analyses performed: Adjusted generalized linear models were used to evaluate the association between GDQS for food purchases (expressed in tertiles: low, mid, and high) and quarterly food expenditures. The analyses were performed at the national level by place of residence and income quintile.

Results: At the national level, the difference in food expenditures between the high- and the low-GDQS groups was +$13.85/AE. By place of residence, the difference between the high- and the low-GDQS groups was +$17.31/AE in urban and +$5.12/AE in rural areas. For income quintile 1 (lowest), there was a statistical difference of -$4.79/AE and +$43.25 for quintile 5 (highest).

Conclusions: Quality of food purchases can be associated with higher or lower expenditures depending on the specific food purchased. High GDQS is associated with lower expenditures among the lowest-income households as they purchase less expensive options compared with high-income households.

Background: Higher coffee intake has been associated with reduced risk of prostate cancer, particularly aggressive forms. The activation of the phosphoinositide 3-kinase (PI3K) signaling pathway plays an important role in prostate carcinogenesis.

Objective: To evaluate associations between prediagnostic coffee intake and a PI3K activation score, the expression/presence of PI3K regulators, and downstream effectors in tumor tissue from men with prostate cancer in the Health Professionals Follow-Up Study, a prospective cohort study conducted in the United States.

Design: A case-only study design was applied. Coffee intake was assessed using validated food frequency questionnaires completed in 1986 and every 4 years thereafter until prostate cancer diagnosis.

Participants setting: Study participants comprised 1242 men diagnosed with prostate cancer from 1986 to 2009 and with tumor markers assessed from tissue microarrays constructed from tumor specimens.

Main outcome measures: The outcomes include the PI3K activation score; expression of insulin receptor and insulin-like growth factor 1 receptor; angiogenesis markers; and presence of the tumor suppressor phosphatase and tensin homolog, chronic and acute inflammation, simple atrophy, and post-atrophic hyperplasia.

Statistical analyses performed: Multivariable linear or logistic regression was conducted to estimate associations between coffee intake and tumor marker expression/presence.

Results: Among coffee drinkers (86.6% of the population), median (25th, 75th percentile) coffee intake was 2 c/day (1, 3 c/day). The associations between coffee consumption and the tumor markers of interest were generally weak with modest precision. When comparing men who drank >3 c/day coffee with nondrinkers, the absolute percent difference in the PI3K activation score and angiogenesis markers ranged from 0.6% to 3.6%. The odds ratios for phosphatase and tensin homolog loss, insulin-like growth factor 1 receptor and insulin receptor expression, and presence of chronic and acute inflammation, simple atrophy, and postatrophic hyperplasia also were not statistically significant, were imprecise, and ranged from 0.82 to 1.58.

Conclusions: Coffee intake was not observed to be associated with PI3K activation, related regulators, and several effectors in prostate tumor tissue. Studies exploring alternative pathways or earlier steps in carcinogenesis are needed to investigate the underlying mechanisms of the coffee and prostate cancer association.

Background: American Indian and Alaska Native (AI/AN) people have high rates of diabetes and limited access to nutrition education. The "What Can I Eat? Healthy Choices for People With Type 2 Diabetes" (WCIE) diabetes nutrition education program was culturally adapted for AI/AN adults.

Objective: This analysis was designed to evaluate the reliability and validity of items developed to measure diabetes nutrition self-efficacy (ie, confidence one can engage in specific behaviors) and diabetes nutrition behavior among participants in the WCIE program for AI/AN adults.

Design: This study was a secondary analysis of data from a randomized controlled trial designed to evaluate the WCIE program for AI/AN adults. Baseline data were used to assess the reliability and validity of the self-efficacy and behavior items, which were collected via survey. Due to COVID-19 safety protocols, the intervention was conducted via Zoom (Zoom Video Communications), and both survey and clinical data were collected at home by participants.

Participants/setting: The study was conducted from January to December 2021 with 5 AI/AN-serving health care programs in Oklahoma, Illinois, North Carolina, California, and New York. AI/AN adults with type 2 diabetes who spoke English and had internet access were eligible. Sixty people participated.

Main outcome measures: Analyses examined validity and reliability of diabetes nutrition self-efficacy and behavior items.

Statistical analysis performed: To test reliability, internal consistency and factor structures of the scales were examined. To evaluate convergent validity, Pearson correlations were computed to examine the association of the self-efficacy and behavior measures with each other and with clinical indicators (ie, body mass index, blood pressure, and hemoglobin A1c).

Results: Two self-efficacy factors were identified. Each showed strong internal consistency (Cronbach α ≥ 0.85; McDonald ω ≥ 0.88) and was directly associated with diabetes nutrition behavior (P < .001). The factor assessing Confidence in Using the Diabetes Plate was inversely associated with hemoglobin A1c (Pearson correlation = -0.32, P = .0243). The behavior measure capturing Healthy Nutrition Behavior showed strong internal consistency (α = 0.89; ω = 0.92) and was inversely associated with hemoglobin A1c (Pearson correlation = -0.38, P = .0057).

Conclusions: Diabetes nutrition self-efficacy and behavior items developed for the WCIE program for AI/AN adults are valid and reliable. These items can facilitate rigorous and consistent evaluation of the AI/AN WCIE program.

Background: Body dissatisfaction is associated with poor psychological and physical health, particularly among young people. However, limited data exist on body size perceptions across countries and factors associated with dissatisfaction.

Objective: This study examined dissatisfaction prevalence and associations with sociodemographics and social media use among youth in 6 countries.

Design: Repeat cross-sectional national online surveys were conducted as part of the 2019 and 2020 International Food Policy Study Youth Survey.

Participants: The sample included 21 277 youth aged 10 to 17 years from Australia, Canada, Chile, Mexico, the United Kingdom, and the United States. Youth were recruited to complete the online survey through parents/guardians enrolled in the Nielsen Consumer Insights Global Panel and their partners' panels.

Main outcome measures: Figural drawing scales assessed self-perceived and ideal body images, with differences between scales representing body dissatisfaction.

Statistical analyses performed: Multinomial logistic regression models examined differences in body dissatisfaction by country, and associations with sociodemographics and either social media screen time or platforms used, including 2-way interactions with country.

Results: Overall, approximately 45% of youth reported the same perceived and ideal body sizes, whereas 35% were "larger than ideal" (from 33% in Canada and Australia to 42% in Chile) and 20% were "thinner than ideal" (from 15% in Chile to 22% in Mexico). Greater social media screen time was associated with a higher likelihood of moderate-severe dissatisfaction for being "thinner than ideal" and at least mild dissatisfaction for being "larger than ideal" (P < .003 for all contrasts), with greater dissatisfaction among users of YouTube and Snapchat than nonusers (P ≤ .005 for both contrasts). Modest differences in body dissatisfaction between countries were observed for age, ethnicity, body mass index, and weight-based teasing.

Conclusions: Body dissatisfaction is prevalent among youth across diverse countries. These findings highlight the need to promote healthy body image in youth, particularly among social media users.