Journal of the Academy of Nutrition and Dietetics最新文献

Background: Malnutrition is associated with increased morbidities and mortality.

Objective: The aim of this systematic review and meta-analysis was to evaluate the effect of medical nutrition therapy (MNT) provided by a dietitian, compared to no MNT on nutrition status and health outcomes (mortality, length of stay (LOS), readmissions, quality of life (QoL), weight, physical function, and cost-effectiveness) in adults with protein-energy malnutrition (PEM).

Methods: MEDLINE, CINAHL, Cochrane Central, Food Science Sources and SPORTDiscus databases were searched for observational and controlled trials published in English in peer-reviewed journals from 2000-September 2024. Risk of bias (RoB) was assessed using Cochrane RoB tools for randomized controlled trials (RCT) and observational studies. Meta-analyses were conducted using the DerSimonian-Laird random-effects model. Certainty of evidence (COE) was assessed using the Grading of Recommendations, Assessment, and Evaluation (GRADE) method.

Results: Fifteen articles representing 11 studies (9 RCTs, 1 non-randomized controlled trial, 1 retrospective cohort) with 86,740 participants were included. RoB for included studies were low (1 study), some concerns (7 studies), high (3 studies). MNT may decrease LOS, increase weight (inpatient), and improve QoL (inpatient) (Low COE). In adults with PEM the effect of MNT on nutrition status, calorie and protein intake, body mass index, handgrip strength, and cost-effectiveness is uncertain. The effect of MNT on mortality was uncertain in outpatient settings and conflicted in inpatient settings, with no effect in pooled RCTs (Low COE) and reduced mortality in an observational study (Moderate COE). Its effect on readmissions was also uncertain in an RCT but may reduce readmissions according to an observational study (Moderate COE).

Conclusion: MNT may improve some outcomes (LOS, hospital readmissions, weight, QoL) in inpatients with PEM, but evidence is uncertain for most outcomes (nutrition status, mortality, weight, handgrip strength, QoL) in outpatient settings and requires more research.

Background: Local wellness policies (LWPs) promote healthy eating and physical activity practices in U.S. schools. Achieving and sustaining quality implementation of LWPs is challenging, particularly in urban and rural schools (which may lack implementation resources).

Objective: Describe implementation strategies and determinants for LWPs in "Wellness in Rural Schools" (WIRES), a national survey of U.S. elementary schools across 4 phases using the Quality Implementation Framework (QIF).

Design: Convergent mixed method analysis.

Participants: /Setting: 559 informants (e.g., principals, nurses, teachers) from U.S. urban and rural elementary schools completed surveys in February 2020; 50 informants (from 39 urban and rural schools) completed semi-structured interviews from April - June 2020.

Main outcome measures: Surveys described implementation strategies and climate. Semi-structured interviews explored implementation determinants across QIF phases.

Statistical analysis performed: For surveys, we conducted descriptive statistics and Poisson logistic regression (adjusted for district clustering, stratification, weighting). Interview data were analyzed deductively using 4 QIF phases: (1) preparing for implementation; (2) creating implementation structure; (3) maintaining structure throughout implementation; (4) assessing future needs. Data were integrated through narrative weaving.

Results: For implementation strategies: 60% percent of survey respondents had "a wellness champion", 59% had a "school-level policy representative", and 37% had an "implementation team." For QIF phase 1, schools with better wellness climates had higher odds of having an implementation team (OR=1.18; CI [1.09,1.29]; p<0.001). In Phase 2, we identified key attributes (e.g., intrinsic motivation) and recruitment strategies for wellness teams/champions, and described facilitators of (e.g., external partners) and threats to (e.g., staff resistance) quality implementation. In Phases 3-4, monitoring approaches differed by implementation strategy (e.g., 74% of policy representatives tracked goals compared to 43% of teams) and limited future action planning (e.g., 25% integrated wellness goals into school improvement plans).

Conclusions: Findings identify how LWP implementation strategies form and are sustained, and identify gap areas across implementation phases. Findings inform tailored support for urban and rural schools to initiate and carry out evidence-informed LWP implementation strategies.

Background: Oxidative stress contributes to the pathogenesis of anxiety disorders. Carotenoids are a group of liposoluble bioactive compounds with antioxidant properties. Few studies have tested associations between intake of carotenoids from dietary sources and anxiety symptoms.

Objective: Assess associations between intake of common dietary carotenoids -alpha-carotene, beta-carotene, beta-cryptoxanthin, lycopene, lutein, and zeaxanthin- derived from two 24-hour recalls, and frequency of self-reported anxiety symptoms.

Design: A cross-sectional study was conducted of the US population from the 2007-2012 National Health and Nutrition Examination Surveys.

Participants/setting: Non-pregnant adults aged ≥20 years with complete data on dietary intake, frequency of anxiety symptoms, and covariates were included (n=11846).

Main outcome measure: Frequency of anxiety symptoms (feeling worried, tense, or anxious in the past 30 days) occurring for ≥ 75% of the past 30 days (≥23 days) vs less often.

Statistical analyses performed: Multivariable logistic regression estimated associations between intake of each carotenoid, in quartiles, and frequency of anxiety symptoms. Covariates included age, gender, education, marital status, family income-to-poverty ratio, energy intake, smoking, history of hypertension and diabetes, and intakes of polyunsaturated fatty acids, vitamins B6, C, and E, and magnesium.

Results: Intakes in the highest quartile of alpha-carotene (OR: 0.69, 95% CI: 0.55 to 0.85), beta-carotene (OR: 0.68, 95% CI: 0.55 to 0.85), beta-cryptoxanthin (OR: 0.58, 95% CI: 0.47 to 0.71), and lutein/zeaxanthin (OR: 0.75, 95% CI: 0.60 to 0.93) were associated with lower odds of anxiety symptoms for ≥75% of the past month, adjusting for socio-demographics. After adjusting for behavioral and dietary variables, only beta-cryptoxanthin intake (OR: 0.67, 95% CI: 0.54 to 0.83) was associated with frequency of anxiety symptoms. Findings were similar using other thresholds for anxiety symptoms (>50% or 100% of past month).

Conclusions: Among US adults in 2007-2012, higher intake of beta-cryptoxanthin was associated with less frequent anxiety symptoms.

Background: Parental overvaluation (parental identity based on their child's weight) and parental weight bias internalization (parents' internalization of societal bias towards people living in larger bodies) are both associated with their children's disordered eating. Less is known about the extent to which these constructs overlap and how their combination may relate to pediatric disordered eating.

Objective: The current study examined the relationship between parental overvaluation, parental internalized weight bias, and children's disordered eating to test whether parental overvaluation was associated with child disordered eating beyond the effects of parent internalized weight bias.

Design: Cross-sectional data were collected from parents in the United States recruited online through Mechanical Turk from March 2021 - January 2022.

Participants/setting: Participants were 196 parents (M_age=38.2 years). Participants were excluded if they were younger than 21 years old, lived with their child less than half the time, or if they failed to meet attention and validity checks embedded throughout assessments.

Main outcome measures: Child disordered eating behaviors (overeating, binge eating, purging, secretive eating) were evaluated.

Statistical analyses performed: Correlations compared parental overvaluation and internalized weight bias. Hierarchical logistical regressions tested the association of internalized weight bias with child disordered eating behaviors and then whether parental overvaluation significantly contributed to the variance in child disordered eating behaviors beyond the effect of internalized weight bias.

Results: Across all child disordered eating behaviors, parent internalized weight bias was significant in the first step of the logistical regression when it was the singular variable (all ps<.005). When both variables were included in models, parental overvaluation, but not weight bias, was significantly associated with all child disordered eating behaviors (all ps<.001).

Conclusions: The extent to which a parent evaluates themselves as a parent based on their child's weight/shape is associated with child disordered eating behaviors more so than internalized weight bias. More research is needed to determine if parent-focused treatment for pediatric eating disorders could benefit from strategies aimed at shifting the valued aspects of parental identity away from child weight/shape.

Background: All-cause mortality risk and dementia occurrence have been previously hypothesized to be linked with food insecurity and poor dietary quality.

Objective: The aims of the study were to test mediation and interactions between food insecurity, diet quality and dementia status in relation to all-cause mortality.

Design: The interplay of food insecurity, diet quality and dementia in their associations with all-cause mortality was studied, in terms of interactions, and mediating effects, using secondary longitudinal data from a sample of older US adults from the Health and Retirement Study (HRS, 2012-2020). Reduced (age, sex, race/ethnicity-adjusted, M1) and fully adjusted (socio-demographic, lifestyle and health-related factor-adjusted, M2) models were tested, and stratification by sex and race/ethnicity was carried out.

Participants/setting: 2,894 US older adults (2012-2014, mean baseline age of 76.4 y) were selected from this national longitudinal sample.

Main outcome measures: The outcome of interest was all-cause mortality risk for follow-up till end of 2020.

Statistical analyses performed: Cox proportional hazards, four-way decomposition and generalized structural equations models (GSEM) were utilized.

Results: Overall, 902 deaths occurred (51 per 1,000 person-years (P-Y). Food insecurity (yes vs. no) was not associated with mortality risk in M1, though inversely related to this outcome in M2, (Cox models and GSEM). Food insecurity was directly related to Ln(dementia odds) in M1 only (β±SE: 0.23±0.05, P<0.001, GSEM). Diet quality as measured by HEI-2015 (z-scored), while inversely related to food insecurity in reduced GSEM (β±SE:-0.18±0.06, P=0.005), was also inversely related to both Ln(dementia odds), z-scored (β±SE:-0.14±0.03, P<0.001) and mortality risk (LnHR±SE:-0.14±0.03, P<0.001, M1). Ln(dementia odds) was strongly associated with mortality risk (HR=1.39, 95% CI: 1.31-1.48, P<0.001, M2). In both four-way decomposition models and GSEM, the total effect of diet quality on mortality risk was partially mediated through Ln(dementia odds) (M1 and M2), explaining 15-21% of this total effect.

Conclusion: Diet quality-mortality risk association was partially mediated through dementia, with inconsistent findings observed for food insecurity.