Journal of the Academy of Nutrition and Dietetics最新文献

Background: The Food and Drug Administration's Closer to Zero Action Plan aims to reduce toxic element exposure from foods infants and toddlers eat. Rice has been identified as a source of inorganic arsenic in the diets of infants and toddlers.

Objective: Evaluate consumption of rice and rice-containing foods from the Feeding Infants and Toddlers Study (FITS) 2016.

Design: FITS was a national cross-sectional survey conducted in 2016. Dietary intakes were collected by trained nutritionists using multiple-pass 24-h recalls by telephone with parents and caregivers of infants and toddlers.

Participants: Participants from FITS 2016 (n=2635) are from a national sample weighted to be representative of US infants and toddlers 0-24 months of age.

Main outcome measures: Rice grain consumption among infants and toddlers and distribution of rice grain consumed was determined using one day intakes. Per capita mean grams rice/day from infant cereal was determined for infants 0-12 months.

Statistical analyses: Sources of rice were identified from 24-h dietary recalls. A percent of rice grain was assigned to each food source and descriptive statistics were used to estimate intakes and distributions.

Results: Percent consuming rice or rice-containing foods was highest for infants 6-11.9 months (58.2%), including snacks (32.1%), infant cereal (27.9%), baby food purees (11.1%) and cooked rice (7.7%). Among infants 6-11.9 months of age that consumed rice, mean intake of rice from all sources was 11.9 ±0.8g/d (mean±SE) and although most frequently reported, snacks provided the least quantity of rice (2.0±0.2g/d). For infants 0-11.9 months of age mean per capita rice intake from infant cereal was 3.3±g/day.

Conclusions: Older infants consume rice from a variety of foods. Rice-containing snacks contribute minimal quantities of rice to the daily diet. To reduce exposure to inorganic arsenic, infants should be offered a variety of grains as part of a well-balanced diet.

The dietetics profession is facing a shortage of registered dietitian nutritionists (RDNs) with a terminal degree. The need for doctoral prepared RDNs was augmented with the entry-level RDN requiring a graduate degree and exacerbated by the number of retirees from the baby boomer generation. Advanced practice doctoral (APD) programs can assist in meeting the increased need for doctoral prepared RDNs. The Accreditation Council for Education in Nutrition and Dietetics Board established an Expanded Standards Committee to develop the APD academic accreditation standards, which included creating and validating doctoral-level competencies in dietetics practice. The development began with a review of the literature, including a review of advanced practice standards for non-dietetic, health-related professional programs and professional-doctorate accreditation standards, and focus groups to investigate the perception and need. A rigorous, iterative, Delphi research process was used to develop the academic standards, competencies, and respective performance indicators. The iterative approach resulted in 8 validated standards with 14 competencies with 34 performance indicators for the academic accreditation APD standards. The APD standards define an advanced practice professional doctorate curriculum that is distinct from the entry-level graduate degree in clinical nutrition programs, as well as the research PhD, as it incorporates advanced didactic coursework, advanced practice residency, and applied practice-based research to achieve specific practice-based competencies. Academic accreditation at the doctoral level ensures quality programs that are educating RDN's who are competent at the advanced-practice level enhancing not only professional practice, but also advancing research supporting practice, education, and leadership.

Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides benefits redeemable for select healthy foods, aligned with the 2020-2025 Dietary Guidelines for Americans, to support healthy diets among pregnant and postpartum women, and their children to age 5 years, living in low-income households. WIC benefits are often not fully redeemed, limiting nutritional benefits of participation.

Objective: The objective of this study was to assess the associations of WIC participant, caregiver, and household characteristics with WIC food benefit redemption.

Design: This was a longitudinal study using WIC administrative data.

Participants/setting: WIC participants served by a program in Southern California from November 2019 to June 2023 (n = 501 527 certification periods; n = 271 116 individuals) were included in this study.

Main outcome measures: Mean WIC benefit redemption percentage in certification periods in benefit categories (ie, cheese/tofu, eggs, breakfast cereal, legumes, canned fish, fruits and vegetables, infant foods [cereal, fruits and vegetables, meats, contract and therapeutic formula], whole grains/bread, yogurt, whole and reduced-fat milk, and 100% juice) and across all categories, continuous and interval-scaled in 10% increments was measured.

Statistical analysis: Multivariable quantile regression and generalized estimating equation ordinal logistic regression models were used to assess associations of WIC participant, caregiver, and household characteristics with median and interval-scaled redemption percentage, respectively, in each and across all categories.

Results: Redemption ranged from very low (infant meats, 5.4%) to very high (infant formula, 96.2%). Median redemption across all categories was 70.6%. Significantly lower redemption was observed for households of Black, White, and other race/ethnicity-language preference individuals (compared with households of Hispanic English-speaking individuals); households with caregivers with lower educational attainment; and households with at least 1 month without food benefits issued, participating in the Supplemental Nutrition Assistance Program, income <100% of the federal poverty level, ≤5 individuals, or only 1 WIC participant.

Conclusions: WIC benefits are used at different rates by WIC participant, caregiver, and household characteristics. Groups with lower redemption may need additional support in using benefits. Maximizing redemption might help all WIC participants derive the full positive nutritional impact of program participation.

Background: Parents are important conduits of weight- and health-related messaging. Weight-related communication and approaches to child feeding used by parents may reflect their past experiences with weight stigma and are understudied pathways through which intergenerational weight stigma may be transmitted.

Objective: The aim of this study was to examine how experienced and internalized weight stigma among parents of children with higher weights are associated with weight-related communication and the feeding practices they use.

Design: The Listening to Parents study is a cross-sectional study of 103 parent-child dyads who completed in-person study visits at the University of Michigan in Ann Arbor between November 2022 through June 2023.

Participants/setting: Participants were parents of children (ages 6 through 14 years, identified by parents as "heavier or overweight") who completed the Stigmatizing Situations Inventory Brief and Weight Bias Internalization Scale-Modified, as well as questions about weight-related communication and the Comprehensive Feeding Practices Questionnaire.

Main outcome measures: Outcomes included 5 items corresponding to parental weight-related communication (ie, self-directed, other-directed, and child-directed weight talk, child-directed weight teasing, and child-directed encouragement to lose weight) and 3 Comprehensive Feeding Practices Questionnaire subscales (ie, Monitoring, Restriction for Health, and Restriction for Weight Control).

Statistical analyses performed: Linear regression models were used to examine associations between mean scored parent-experienced and parent-internalized weight stigma and weight-related communication and feeding practices. Models were adjusted for child gender, parent-perceived child weight status, parental race and ethnicity, parental body mass index, and household income-to-needs ratio.

Results: In covariate-adjusted models, parent-internalized weight stigma was positively associated with self-directed weight talk (β = .20, SE = .078; P = .01) and greater use of health-related restrictive child feeding practices (β = .16, SE = .070; P = .02). No other significant associations in covariate-adjusted models were observed.

Conclusions: Although parents with greater internalized weight stigma may engage in more self-directed weight talk, they may also be more attuned to the harms of weight stigma and seek to minimize child-directed weight talk and weight teasing.

Background: Emerging evidence indicates water insecurity (WI) is detrimental to nutritional outcomes and dietary choices.

Objective: WI experiences were measured alongside market and traditional sugar-sweetened beverage (SSB) consumption in a small-scale society experiencing the early stages of a nutrition transition (ie, lifestyle and dietary changes away from traditional foods) to test how they are associated.

Design: The 12-item Household Water Insecurity Experiences (HWISE) scale was implemented along with a cross-sectional retrospective survey of beverage intake and sociodemographic characteristics across 5 communities at varying distances from a market town.

Participants/setting: Participants were Tsimané forager-horticulturalist adults aged 16 years and older (n = 455; 47% were women) in lowland Bolivia from April through May 2019.

Main outcome measure: Sugar-sweetened beverage consumption and traditional beverage consumption were measured.

Statistical analyses performed: Multivariate logistic and Poisson regressions were performed, adjusting for possible confounding variables, including age, gender, income, household water needs, and community residence.

Results: Using logistic regressions, each point higher WI (HWISE) score was associated with 23% (95% CI 1.01 to 1.50; P = .035) and 27% (95% CI 1.06 to 1.52; P = .008) higher odds of consuming an SSB in the past week for men and women, respectively. For men, each point higher HWISE score was associated with 13% (95% CI 1.10 to 1.16; P < .001) higher odds of drinking chicha fuerte (ie, a traditional, homemade fermented beverage with antibacterial properties) and 16% (95% CI 1.02 to 1.32; P = .022) higher odds of consuming liquor. SSB consumption was highest in the closest communities to the market town and declined significantly with distance; and traditional beverages, such as chicha dulce (a sugar-sweetened, unfermented homemade chicha), were lowest in the close communities and increased with distance to the market town.

Conclusions: Among Tsimané adults living in the Bolivian Amazon experiencing the nutrition transition, WI was associated with greater SSB intake. Distance to the main market town shaped access and preferences, as it was associated with SSB and traditional beverage consumption.

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, 3 databases (PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature) were searched from January 1980 to June 2023 for obesity prevention interventions that utilized home visitation as a treatment modality, targeted children aged 5 years or younger, reported on child weight outcomes, were experimental or quasiexperimental 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 1 obesogenic behavioral outcome in the intervention group compared with 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 behavior-related outcomes, as well as explore the influences of the interventionist type, program duration, inclusion of nonmaternal caregivers, and use of technology on childhood obesity-related outcomes.

Background: Although 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, DC, metro area and to have them identify feasible and influential 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 believed were influential 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 during July 2022 in Washington, DC.

Statistical analysis: Using member checking and iterative feedback, the research team synthesized the outputs from the workshop into 1 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 increase public health spending (high impact/hard to do); invest in new and updated infrastructure for public water (high impact/hard to do); implement coordinated public health campaigns to promote drinking safe, palatable water as an alternative to SSB (low impact/easy to do); provision of tap water filters (low impact/easy to do); and 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.