Journal of the Academy of Nutrition and Dietetics最新文献

Background: The US Department of Agriculture promotes farm to school (F2S) as an evidence-based approach to help school meals meet updated nutrition standards that promote health. California is a key agricultural state with strong support for F2S to promote local agriculture and equitable access to nutritious food for all students.

Objective: Examine district characteristics associated with F2S participation among California public districts during the 2018-2019 school year.

Design: Cross-sectional evaluation of 2019 US Department of Agriculture Farm to School Census data.

Participants/setting: California public districts responding to the 2019 US Department of Agriculture F2S Census (N = 572).

Main outcome measure: Reported participation in F2S activities in 2018-2019. Covariates included district size, annual per-pupil spending, urbanicity, racial/ethnic composition, and percent free and reduced-price meal (% FRPM) eligibility.

Statistical analysis: Descriptive statistics (unweighted frequency and weighted percent) were reported for demographic characteristics. Weighted, multiple logistic regression assessed associations between demographic characteristics and F2S participation, reported as odds ratios (95% CI).

Results: Nearly 78% of California respondents reported F2S participation. Top activities were serving local food in school lunch (73%) and breakfast (65%) and local food promotion at school (45.5%). The odds of participation among districts with enrollments ≥1000 were 1.79 (95% CI 1.15 to 2.79) times higher than smaller districts and 1.57 (95% CI 1.08 to 2.28) times higher in districts with lower annual per-pupil spending (≤$13 707). No significant differences were found by racial/ethnic composition, % FRPM eligibility, or urbanicity.

Conclusions: Disparities in F2S participation exist for small districts and those with high annual per-pupil spending that may lack the advantages of economies of scale. Grant incentives and support networks for these groups are recommended along with increased monitoring focused on the quality of F2S engagement. Administration of a brief annual state F2S Census could support more timely monitoring and accountability to align with state goals and improve opportunities for data sharing and community engagement.

Background: In the United States, a means-tested approach is often used to provide free or reduced-price meals (FRPM) to students from lower-income households. However, federal income thresholds do not account for regional cost of living variations. Thus, many ineligible households may be at risk for food insecurity. Universal free school meal (UFSM) policies may help address this issue, especially in states with a higher cost of living.

Objective: To evaluate parent perceptions of the influence of Massachusetts' statewide UFSM policy on households eligible and ineligible for FRPM.

Design: Cross-sectional survey of parents across income categories conducted during the 2022-2023 school year.

Participants/setting: Massachusetts parents (N = 403) with children in grades kindergarten through grade 12 with incomes ranging from <185% of the federal poverty level to >300% of the federal poverty level.

Main outcome measures: Parents' perceived influence of Massachusetts' UFSM policy on their child and household.

Statistical analyses performed: Analysis of variance examined differences in the perceived impact of UFSM by FRPM eligibility, adjusting for demographic characteristics.

Results: Households that were FRPM eligible or near eligible were significantly more likely to report that their ability to have enough food for their family would be harder without UFSM (P < .0001) compared with those in the highest income category. Across all income categories, approximately 75% of parents reported that school meals should be free for all children, and UFSM saved their family money and time and reduced stress, with no significant differences by FRPM eligibility. Roughly half (52%) reported their household finances would be hurt and 42% of parents from households eligible for FRPM reported their child would be less likely to eat school meals if the UFSM policy ended.

Conclusions: This study found strong parent support of UFSM policies regardless of income level. In addition, parents perceived that discontinuing UFSM may adversely influence school meal participation, including among students from lower-income households, as well as food security among households ineligible for FRPM, particularly in areas with higher costs of living. Policies to expand UFSM should be considered among additional states and at the national level.

Background: Type 2 diabetes mellitus (T2DM) disproportionately affects African American (AA) populations. Despite the importance of diet in diabetes management, the association of diet quality and/or the degree of food processing with glycemic control in AA adults with T2DM remains unclear.

Objective: This study aimed to examine associations between diet quality scores and the degree of processing in the diet with glycosylated hemoglobin (HbA1c) level in AA adults with T2DM.

Design: This cross-sectional study used baseline data from participants in Texas Strength Through Resilience in Diabetes Education, an ongoing clinical trial.

Participants/setting: Participants involved in this analysis (N = 273) were AA adults with T2DM recruited through local churches in Austin, TX, and the surrounding areas from August 2020 through April 2023.

Main outcome measures: Participants provided 2 24-hour dietary recalls (1 weekend and 1 weekday) and a blood sample to measure HbA1c level. Healthy Eating Index 2015, Alternative Healthy Eating Index 2010, and Alternate Mediterranean Diet scores were calculated. The NOVA method was used to calculate the percentage of grams and calories that came from ultraprocessed foods and unprocessed or minimally processed foods.

Statistical analyses performed: Linear regression and analysis of variance models tested associations between the diet quality scores and degree of food processing with HbA1c level, adjusting for demographic covariates. Models were stratified by insulin use after finding a significant interaction with ultraprocessed foods and unprocessed or minimally processed foods.

Results: Regression analyses revealed that the percentage of grams in the total diet from ultraprocessed foods was positively associated with HbA1c level (β_adj = .015; P_adj = .032), whereas unprocessed or minimally processed foods were inversely associated with HbA1c level (β_adj = -.014; P_adj = .043). There was no significant association between any diet quality score and HbA1c level.

Conclusions: In AA adults with T2DM, only the degree of food processing was associated with HbA1c level. Future research should explore whether a causal relationship exists between food processing and HbA1c level and investigate mechanisms by which ultraprocessed foods may affect glycemic control.

Background: Registered dietitian nutritionists (RDNs) are important members of interprofessional health care teams; yet, there is limited research of RDN perspectives of interprofessional teams.

Objective: To examine associations between the characteristics of RDNs and their attitudes of team-based care (TBC).

Design: A cross-sectional electronic Qualtrics survey encompassing demographic questions, the Attitudes Toward Interdisciplinary Health Care Teams (ATIHCT) scale, and additional interprofessional-related items was distributed to RDNs during January 2020.

Participants/setting: A total of 5018 RDNs from various regions/specialties in the United States were recruited primarily via direct email from a random list of RDNs obtained through the Commission on Dietetic Registration. The final sample was N = 616; 12.3% of RDNs and 88.1% of RDNs who initiated the survey.

Main outcome measures: ATIHCT subscale scores, which measure attitudes regarding efficiency of TBC and service quality of TBC.

Statistical analyses performed: Multiple linear regression modeled area of specialty, time with RDN credential, location, sex, frequency of TBC, and how valued the RDN perceived him or herself to be as independent variables, with ATIHCT subscales as outcome variables. Data were subjected to confirmatory factor analysis to determine appropriate use of the ATIHCT scale in the sample.

Results: Foodservice (β = -1.48; P = .004) and sports nutrition RDNs (β = -2.58; P = .014) had lower scores for attitudes regarding efficiency of TBC (subscale 1) than clinical RDNs. Greater perceived value of the RDN was associated with higher scores for attitudes regarding efficiency (β = .66; P < .001). Greater perceived value of the RDN (β = .13; P = .03) was associated with higher scores for attitudes regarding service quality of TBC (subscale 2).

Conclusions: Specialty and perceived RDN value are associated with more favorable interprofessional attitudes among RDNs. To support positive attitudes regarding interprofessional collaboration, efforts should be honed to foster appreciation and clarity of the RDN's role in TBC.

Background: Although previous research has attempted to understand the barriers and enablers of oral intake in hospitalized patients, these studies have mainly focused on short-stay inpatients and lacked a theory-driven examination of the determinants that influence dietary behavior in the hospital.

Objective: To explore and compare the factors influencing adequate and poor oral intake in long-stay acute patients (admitted >14 days).

Design: A qualitative descriptive study with semistructured interviews.

Participants/setting: Twenty-one adult inpatients (13 men, 8 women) admitted to 2 medical and 2 surgical wards at a tertiary hospital in Brisbane, Australia, during 2022, stratified by the Subjective Global Assessment. Analysis performed Transcripts were initially deductively analyzed against the Theoretical Domains Framework, and a reflexive thematic approach was used to create overall themes.

Results: Of the 21 included patients (median age = 68.0 years, IQR 34 years), 11 had adequate/improved intake and 10 poor/decreased intake. Six themes were identified to have influenced oral intake in long-stay patients: self-determination to eat; nutrition impact symptoms; foodservice characteristics and processes; nutrition-related knowledge and skills; social support; and optimism, emotions, and emotion regulation. Patients with adequate/improved oral intake were characterized by an autonomous motivation to eat. They had increased awareness about their nutritional status, knowledge, and skills about food for recovery, were more optimistic, and social support was an important enabler to eating. In contrast, patients with poor/decreased oral intake perceived nutrition impact symptoms and dislike of meals as the main barriers to eating in the hospital; however, they also expressed more negative emotions, reduced coping strategies, and decreased knowledge, skills, intrinsic motivation, and capabilities to eat. Social support was present but did not enable oral intake in this patient group.

Conclusions: This study provides novel insights into the factors that influenced oral intake in long-stay acute patients, highlighting the importance of patient-centered nutrition care, encompassing motivational interviewing techniques and collaboration from the multidisciplinary team to create a supportive environment that fosters autonomy and empowers patients to actively participate in their own nutrition and recovery.

The Academy of Nutrition and Dietetics' Telehealth Task Force was charged with developing a telehealth policy stance to guide the work of the Academy. The task force comprised representatives from diverse areas of telehealth practice, including research, practice, payment, and licensure. They convened in 2020-2021 to conduct an environmental scan and develop a recommended stance on telehealth policy. The tenets of the resulting telehealth stance are (1) Nutrition care services are critical to comprehensive health care delivery systems and should be covered when provided via telehealth under the same coverage and payment policies as in-person care; (2) Patients should have coverage for telehealth delivered via audio only if they cannot effectively access or use audio-visual technologies; (3) In declared emergency situations when access to qualified providers is otherwise severely impacted, the modification of certain consumer protection policies, such as licensure and Health Insurance Portability and Accountability Act requirements, may be appropriate; (4) Public funding and support for broadband internet, technology, digital literacy education, and language services are necessary to address racial, economic, and geographic health disparities and to address disabilities; and (5) Publicly funded research on telehealth should be nationally representative and include a wide variety of services and providers, including nutrition care services provided by registered dietitian nutritionists and nutrition and dietetic technicians, registered. The telehealth policy stance was formally adopted by the Academy in April 2021.

Background: The relationships between diet quality and health care costs have not been explored beyond 15 years.

Objective: To investigate relationships between both baseline diet quality and change in diet quality over time with cumulative data on health care claims and costs over 21 years among Australian women.

Design: This is a secondary analysis of data from a cohort study, the Australian Longitudinal Study on Women's Health.

Participants/setting: Data for women born between 1946 and 1951 included diet quality data at baseline (2001, n = 8228), change in diet quality (2001-2013, n = 6553), and cumulative administrative health care data (2001-2021).

Main outcomes: Diet quality was assessed using the Australian Recommended Food Score (ARFS) and the Fruit and Vegetable Variety Score. Twenty-one-year cumulative Medicare Benefits Schedule data (number of claims; total charges [$USD]), Australia's universal health care coverage, were reported by baseline ARFS quintile and category of diet quality change ("diet quality worsened" [ARFS decrease ≤ -4 points], "remained stable" [-3 ≤ change in ARFS ≤ 3 points] or "improved" [ARFS increase ≥ 4 points]).

Statistical analysis: Linear regression analyses were conducted and adjusted for socioeconomic, health, and lifestyle factors.

Results: Higher baseline vegetable ARFS were correlated with fewer 21-year cumulative Medicare claims (β = -4.9, 95% CI, -7.3, -2.4) and charges (β = -$214; 95% CI, -$341; -$88). Baseline higher dairy scores were correlated with higher Medicare claims (β = 17.2; 95% CI, 11.1, 23.3) and charges (β = $762; 95% CI, $448, $1076). Compared with women whose diet quality score remained stable, those whose diet quality worsened over time made significantly more claims and higher charges; median (Q1, Q3) 413 (277, 588) claims, $17 868 ($11 037, $27 808) cumulative charges, compared with 387 (259, 559) claims, and $16 953 ($10 033, $26 604) cumulative charges. Change in total ARFS and ARFS subscales were predictors of 21-year cumulative health care claims. For each 1-point increase in ARFS over time, 1.2 fewer health care claims were made (95% CI, 0.3-2.2). Increasing vegetable and dairy ARFS scores were correlated with significantly fewer claims.

Conclusions: Baseline greater variety of vegetables was correlated with fewer 21-year health care claims and costs. Worsening diet quality over time was correlated with greater cumulative health care claims and costs. Consideration of dietary quality and variety in national policy is suggested to potentially reduce national health care claims and costs.

Background: Evidence is lacking to inform how micronutrient deficiencies should be prevented and treated before metabolic-bariatric surgery to optimize patient outcomes.

Objective: This systematic review aimed to examine the effect of preoperative repletion strategies for micronutrient deficiencies on micronutrient biochemistry, quality of life, and complication rates among candidates for metabolic and bariatric surgery compared with usual care, alternate strategies, or no treatment.

Methods: PubMed, Embase, CINAHL, and CENTRAL was searched in April 2024. A grey literature search was updated in April 2024 via Google search. Eligible observational and interventional studies were those that provided micronutrient repletion before the surgery and measured micronutrient status pre- and/or postsurgery. Studies with participants who were pregnant, lactating, or elected jejunocolic bypass, jejunoileal bypass, vertical banded gastroplasty, and biliopancreatic diversion were excluded. Risk of bias was assessed using the Academy of Nutrition and Dietetics Quality Criteria Checklist. Findings were narratively synthesized and the Grading of Recommendation, Assessment, Development and Evaluations was adopted when applicable. Twenty studies (n = 27 groups) were included (n = 15 observational; n = 5 interventional).

Results: Strategies targeted vitamins A, D, E, B6, B12, C, thiamin, folate, calcium, iron, selenium, and zinc, including chronic dosing of oral supplements and multivitamins (n = 21), megadoses of oral supplements (n = 1), intramuscular injection (n = 1), intravenous infusion (n = 1), and a mix of injection and oral supplements (n = 3). Preoperative repletion strategies varied in efficacy. Chronic dosing of oral supplements increased vitamin D levels (n = 4 interventional studies; Grading of Recommendation, Assessment, Development and Evaluations rating: moderate). Multivitamins did not improve vitamin B12 status but improved status of vitamin B6, vitamin C, and folate. Iron infusion (n = 1) increased ferritin levels, despite small sample size and low adherence rate, whereas oral iron supplementation resulted in unchanged (n = 4) or decreased (n = 1) ferritin levels.

Conclusions: Proactive and personalized micronutrient repletion schedules may decrease the risk of preoperative and early postoperative deficiency.