Journal of the Academy of Nutrition and Dietetics最新文献

Background: Two facets of positive body image, body appreciation and functionality appreciation, are positively associated with an adaptive eating style known as intuitive eating. Little is known about the mechanisms underlying the association between positive body image and intuitive eating, although it is well established that weight bias internalization is associated with unfavorable views of the self and body and interferes with health behavior engagement.

Objective: The present cross-sectional study examined weight bias internalization as a statistical mediator of the association between positive body image (ie, body appreciation and functionality appreciation) and intuitive eating.

Design: An online cross-sectional survey was conducted with a convenience sample of adults who were recruited through social media from February to April 2019.

Participants and setting: The final sample included 178 participants (120 women, 55 men, 2 gender nonbinary; mean age = 26.34 years, SD = 9.53 years) who completed the study online.

Main outcome measures: Participants completed the Intuitive Eating Scale-2 as the main outcome measure.

Statistical analyses: The PROCESS macro was used to conduct 2 mediation analyses with body appreciation and functionality appreciation as the antecedents, intuitive eating as the outcome, and weight bias internalization as the mediator.

Results: As expected, body appreciation (b = .34, SE = .06; P < .001) and functionality appreciation (b = .13, SE = .06; P = .043) had significant positive associations with intuitive eating. Weight bias internalization statistically mediated the association between body appreciation and intuitive eating (b = .24, SE = .07, 95% CI .114 to .376), and functionality appreciation and intuitive eating (b = .04, SE = .03, 95% CI .004 to .104).

Conclusions: These findings contribute to better understanding the mechanisms connecting positive body image and intuitive eating. Results from this cross-sectional study indicate weight bias internalization statistically mediates the associations between body appreciation and intuitive eating and functionality appreciation and intuitive eating.

Background: Allostatic load (AL) is a comprehensive indicator of chronic stress. Foods with pro-inflammatory properties can increase the risk of elevated AL levels. However, no studies have explored the association between AL and dietary inflammation.

Objective: The aim of this study was to investigate the relationship between Dietary Inflammatory Index (DII) scores and AL.

Design: This cross-sectional study examined dietary data from 24-hour dietary recalls and biomarkers associated with AL in adult participants 18 years and older from the National Health and Nutrition Examination Survey (2017-2020).

Participants/setting: The National Health and Nutrition Examination Survey examines a nationally representative sample of approximately 5000 individuals each year. A total of 15 560 participants were surveyed during the 2017-2020 period, and 1577 participants were ultimately included in this study.

Main outcome measures: Twenty-six dietary components were selected to calculate the DII, and 10 biomarkers representing the cardiovascular, metabolic, and immune systems were chosen to calculate the AL.

Statistical analyses performed: Logistic regression and linear regression analyses were used to investigate the relationship between DII and AL and between each biomarker. Subgroup analyses were conducted based on sociodemographic variables, including age, sex, race and ethnicity, and BMI.

Results: The risk of high AL was 1.53 times higher in those with DII scores in the highest quartile than in those with DII scores in the lowest quartile (odds ratio [OR] 1.53; 95% CI 1.00 to 2.36; P_trend = .04). For each unit increase in DII, the probability of having high AL increased by 11% (OR 1.11; 95% CI 1.01 to 1.21; P_trend = .03). Higher DII scores were significantly associated with higher systolic blood pressure, diastolic blood pressure, pulse, waist-to-hip ratio, and high-sensitivity C-reactive protein levels. Higher DII scores were also significantly associated with lower total cholesterol and high-density lipoprotein cholesterol levels (P < .05). The association between DII score and AL was more pronounced in women (OR_Quartile3vs1 2.04; 95% CI 1.15 to 3.61; OR_Quartile4vs1 2.07; 95% CI 1.18 to 3.62; P_trend = .01) and in those with a BMI < 24.9 (OR_Quartile3vs1 4.74; 95% CI 1.21 to 18.05; P_trend = .03).

Conclusions: This study found that higher DII scores were associated with greater risk of high AL. Further research with more rigorous study designs is needed to build on these results and evaluate the effect of diets with low inflammatory potential (low DII scores) on AL.

Background: Food insecurity is associated with poor health and development among young children, with inconsistent findings related to longitudinal growth.

Objective: The aim of this study was to investigate associations between household and child food insecurity and young children's weight trajectory during ages 0 to 2 years.

Design: Longitudinal survey data were analyzed for years 2009 to 2018.

Participants/setting: Racially diverse mothers of 814 children ≤24 months interviewed twice (interval >6 months, mean 11 months) in emergency departments of 4 US cities. Children were included if born at term, with birth weight within 2500 to 4500 g, and weight-for-age z score within ±2 SD at first interview.

Main outcome measures: Weight-for-age z score difference between 2 visits was defined as "expected weight gain" (within ±1.34 SD), "slow weight gain" (< -1.34 SD), or "rapid weight gain" (> +1.34 SD).

Statistical analyses performed: Multinomial logistic regression was conducted to examine adjusted associations between household or child food insecurity and weight-for-age z score differences.

Results: Of 814 children, 83.5% had expected weight gain, 7% had slow weight gain, and 9.5% had rapid weight gain, with mean ± SD of 11 ± 4 months between visits. Child food insecurity, but not household food insecurity, was associated with slow weight gain (adjusted relative risk ratio 2.44; 95% CI 1.16 to 5.13 and adjusted relative risk ratio 1.30; 95% CI 0.69 to 2.51, respectively). Neither exposure was associated with rapid weight gain.

Conclusions: The association between child food insecurity and slow weight gain during the first 2 years of life raises clinical concern. Tracking child food insecurity in addition to household food insecurity can be an effective strategy to prevent weight faltering and to support optimal child growth.

Background: The US Department of Agriculture (USDA) Protein Food ounce-equivalents are designed to identify plant sources of protein foods and provide serving size substitutions. Although the ounce-equivalent concept is simple, it fails to generate equivalent exchanges for protein or essential amino acids (EAAs).

Objective: To accurately define the EAA content of USDA Protein Food ounce-equivalents, to develop a more accurate food exchange list, and to evaluate the EAA-9 protein quality framework as a tool for determining precise EAA-equivalent substitutions.

Design: The USDA National Nutrient Database (Standard Reference Legacy) and the EAA-9 protein quality model were used to evaluate the validity of the USDA Protein Food ounce-equivalents for creating equivalent protein and EAA substitutions. The EAA-9 framework then established EAA-9 Equivalence serving sizes to meet EAA requirements.

Main outcomes: EAA composition in protein foods was assessed. EAA-9 Equivalence servings were developed.

Statistical analysis: EAA composition was calculated for USDA Protein Food ounce-equivalents. EAA-9 scores were calculated for protein foods and compared using an egg's EAA composition as a standard. MyPlate Kitchen Recipes were used to apply USDA Protein Food ounce-equivalent exchanges and EAA-9 Equivalence servings.

Results: The USDA Protein Food ounce-equivalents are not equivalent in protein or EAAs, with the disparity ranging from 1 ounce-equivalent of chicken breast with 9.1 g protein and 4.0 g EAAs to 1 ounce-equivalent of almonds with 3.0 g protein and 0.9 g EAAs. Using the USDA serving of 1 egg as a standard for comparing protein food groups, <15% of beans, peas, and lentils and 0% of nuts and seed ounce-equivalents achieve the EAA composition of an egg. EAA-9 Equivalence servings are truly equivalent, with each serving providing a reliable and interchangeable protein source. The EAA-9 Equivalence servings have been calculated and are now available for all USDA Standard Reference Legacy foods with a complete EAA profile, offering a resource for exchanges that ensure EAA requirements are met.

Conclusions: Creating ounce-equivalent substitutions for protein foods requires creating food exchanges that assure EAA requirements are met. The USDA Protein Food ounce-equivalents provide inadequate guidance for balancing EAA requirements.

Background: Malignant bowel obstruction (MBO) is experienced by many with advanced cancer. Patients with MBO cannot eat and may have reduced ability to eat once the acute process has resolved. Sparse data exist to describe oral intake capacity and adequacy of nutrition in patients with MBO. These data are critical to developing effective supportive care nutrition therapy for patients with MBO.

Objective: The aim of this study was to describe the ability to consume food and liquids orally, estimating nutritional adequacy of diet in a sample of patients who received surgical or nonsurgical treatment for MBO.

Design: A descriptive secondary data analysis of repeated dietary intake measures from S1316, a pragmatic comparative effectiveness trial of surgical and nonsurgical treatment for MBO. Participant enrollment occurred between 2015 and 2020. Ability to eat was assessed through self-reported telephone survey and intake was estimated using telephone-based 24-hour recalls, applying US Department of Agriculture multipass methodology.

Participants/setting: The primary trial was conducted within the SWOG Cancer Research Network and included recruitment sites across the United States and Latin America. Eligible participants were diagnosed with, and hospitalized for, MBO.

Main outcome measures: The main outcomes measures were self- or caregiver-reported ability to eat, as well as overall nutrient intake.

Statistical analysis: Descriptive statistics were used to report patient characteristics, intake, and nutrient adequacy. Nutrient intake was presented by tertiles of gastrointestinal symptom severity and assessed.

Results: Two hundred twenty-one participants were registered; 199 were eligible and included. At week 1, 51% of patients with MBO reported consuming some solid food orally; 34% reported no oral intake; and 13% were on enteral feeding only. For patients alive and responsive to recalls at 13 weeks (n = 57), 82% (n = 47) reported consuming solid food. Compared with recommendations, mean reported intake was inadequate for most nutrients.

Conclusions: Oral intake is reported in more than one-half of patients diagnosed with MBO. Medical nutrition therapy should be tailored to patient's tolerance for eating and with consideration or patient's desire to address nutritional inadequacies.