Journal of the Academy of Nutrition and Dietetics最新文献

Background: Fruit drinks are the top source of added sugar in young children's diets, increasing their risk of chronic disease. It is unclear to what extent front-of-package marketing and disclosures influence parents' perceptions of fruit drinks and their intentions and decisions to purchase them. These data are needed to inform regulatory and legal action to reduce potentially misleading marketing and help parents make healthier choices for their children.

Objective: This systematic review investigated the relationship between fruit drink front-of-package claims (nutrient, natural/implied-natural, or health-related), fruit imagery, and ingredient disclosures (sugar, nonnutritive sweeteners, and juice content) and consumer perceptions, intentions, and behavior.

Methods: A comprehensive search was used to identify peer-reviewed, original quantitative, and/or qualitative research published any time using the following databases: PubMed, Embase, PsycInfo, CAB Abstracts, Web of Science Core Collection, and Business Source Complete. Searches were conducted during May 2022 and January 2023. Risk of bias was assessed using the Quality Assessment Tool for Quantitative Studies and the Critical Appraisal Skills Programme checklist for qualitative studies. Articles were grouped by exposure and narratively synthesized.

Results: Sixteen articles met inclusion criteria. Reviewed studies found that natural claims-and, to some extent, nutrient claims and fruit imagery-are associated with increased selection, purchase intentions, perceived healthfulness, and appeal of fruit drinks; as well as increased misunderstandings of fruit drink juice content (overestimation) and added sugars content (underestimation). Ingredient disclosures-including percent-juice content and presence of added sweeteners-may help correct misperceptions about product healthfulness.

Conclusions: Front-of-package claims and imagery can increase healthfulness misperceptions and selection of fruit drinks, and ingredient disclosures could partially correct those misperceptions. The US Food and Drug Administration should consider updating fruit drink front-of-package marketing regulations. More high-quality randomized experiments would be useful to inform federal and legal action to support parents in selecting healthier beverages for their children.

Background: This article is part of a series of articles in the Journal of the Academy of Nutrition and Dietetics exploring the importance of research design, epidemiological methods, and statistical analysis as applied to nutrition and dietetics research. The purpose of this ongoing statistical portfolio is to assist Registered Dietitian Nutritionists (RDN) and Nutrition and Dietetic Technicians, Registered (NDTR) in interpreting nutrition research and applying scientific principles to produce high-quality data analysis. Advances in technology are promoting faster, easier, and often more diverse data collection and analysis. Consumers and practitioners alike are rapidly adopting electronic communication preferences (ie, telehealth, mobile applications, social media). This article, which accompanies the companion article on basic survey research, is an overview of electronic internet-mediated survey methodology for data collection and analysis in nutrition and dietetics research. Its purpose is to highlight the unique requirements in electronic planning and administration for surveys that builds on basic survey principles. This includes the effect of internet-mediated data methodology on an array of research parameters, including evaluation of software functions for the investigator and survey navigation issues for the participant. A Checklist for Reporting Electronic Survey Statistics (CRESS) is provided as a guide for data dissemination in nutrition and dietetics research.

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-hour 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 1-day intakes. Per capita mean grams rice/day from infant cereal was determined for infants aged 0-12 months.

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

Results: Percentage consuming rice or rice-containing foods was highest for infants aged 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 who consumed rice, mean intake of rice from all sources was 11.9 ± 0.8 g/d (mean ± standard error [SE]), and although most frequently reported, snacks provided the least quantity of rice (2.0 ± 0.2 g/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 nondietetic, 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 RDNs 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.