Journal of the Academy of Nutrition and Dietetics最新文献

Background: Mindful eating, a practice that encourages attention to sensations and awareness during the eating experience, has shown effectiveness in inducing positive behavioral changes. Mindful eating practices have been examined in relation to energy intake (i.e., quantity of food) but to a lesser extent to the quality of that food; hence, it is crucial to comprehensively understand the association between mindful eating and diet quality.

Objective: The objective of this study was to examine the association between mindful eating and diet quality among US adults with lower incomes and to examine heterogeneity in the associations by gender identity.

Design: This study employs a cross-sectional study design.

Participants/setting: During December 2022, a national convenience sample of 1798 US adults with lower incomes, recruited through Prime Panels, completed a web-based survey.

Main outcome measures: Diet quality was measured using the 30-day Prime Diet Quality Score screener (PDQS-30D) (score range = 0 to 126). A higher score reflects higher diet quality.

Statistical analyses performed: Associations between the Mindful Eating Questionnaire (score range = 1 to 4) and its 4 factors (Awareness, External Cues, Emotional Response, and Distraction) in relation to diet quality were examined using multivariable regression models, adjusting for sociodemographic covariates.

Results: The mean Mindful Eating Questionnaire score was 2.30; the mean PDQS-30D score was 50.2. The associations between Mindful Eating Questionnaire scores and PDQS-30D scores were significantly modified by gender identity. Among men, a higher Mindful Eating Questionnaire score reflecting more mindful eating (β = 3.81, 95% CI 2.19 to 5.43) was associated with higher PDQS-30D scores. In addition, a higher Awareness factor score (β = 3.21, 95% CI 2.48 to 3.93), a higher External Cues factor score indicating less response to external cues (β = .76, 95% CI 0.01 to 1.52), and a higher Distraction factor score indicating less distraction (β = 1.09, 95% CI 0.28 to 1.90), were all associated with higher PDQS-30D scores. Among women, a higher Awareness factor score was associated with higher PDQS-30D scores (β = 2.50, 95% CI 1.78 to 3.22); and a higher Emotional Response factor score (ie, eating less in response to emotional eating) was associated with lower PDQS-30D scores (β = -.85, 95% CI -1.58 to -.12).

Conclusions: Mindful eating and its factors are associated with a higher diet quality among US adults with lower incomes, particularly among men. Future longitudinal and intervention studies are warranted to better understand these associations among adults with lower incomes, as an understudied population in the mindful eating literature.

Background: Implications of lifelong, perceived discrimination on nutrient intake during the preconception period are unclear.

Objective: The objective was to identify associations between perceived discrimination and consumption of specific nutrients associated with risk of adverse pregnancy outcomes.

Design: This is a secondary data analysis of the prospective Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be cohort. Participants completed a Block food frequency questionnaire assessing diet during the 3 months before pregnancy and a Krieger Experiences of Discrimination Scale assessing personal encounters of discrimination.

Participants and setting: Participants were recruited from 8 clinical centers across the United States between 2010 and 2013. Each participant completed the food frequency and Krieger questionnaires and self-identified as belonging to a minoritized racial or ethnic group for this analysis (n = 2457).

Main outcome measures: Main outcomes include reported total energy and macronutrient intake, percent of energy from macronutrients, saturated and unsaturated fatty acids, added sugar, sodium, dietary fiber, and Healthy Eating Index-2010 Seafood and Plant Proteins component score.

Statistical analyses performed: Participants were grouped as reporting fewer (< 3) or more (≥ 3) circumstances of discrimination on the Krieger scale. Multivariable regression models examined associations between discrimination group and nutrient intake. Variables with nonnormal distributions were log transformed. Associations were adjusted for total energy intake. Primary outcomes underwent false discovery rate correction.

Results: Those reporting 3 or more circumstances of discrimination had higher reported energy intake (P = .002) and higher reported intake of total fat, saturated fat, unsaturated fats, protein, added sugar, and sodium after false discovery rate correction (all P values < .05) compared with those reporting fewer circumstances. After adjustment for total energy intake, reporting 3 or more circumstances was associated with greater reported intake of saturated fat and n-3 polyunsaturated fatty acids, and lower reported intake of dietary fiber (all P values < .05).

Conclusions: Reporting 3 or more circumstances of discrimination was associated with higher reported total energy intake. After adjustment for total energy, reporting 3 or more circumstances of perceived discrimination was associated with less nutritious intake for some (higher saturated fat and lower dietary fiber) but not all (higher eicosapentaenoic and docosahexaenoic acids) nutrients.

Background: Universal school meals (USM) aim to eliminate barriers to school meal access by providing free meals to all students regardless of family income. During the COVID-19 pandemic, US Department of Agriculture waivers allowed schools nationwide to offer meals free of charge to all students. Although USM have demonstrated positive effects on student health and participation, limited research has focused on the perspectives of the foodservice directors (FSDs) who manage them.

Objective: The study aimed to explore the operational benefits and challenges encountered by FSDs, and their perceptions of the benefits of USM for students and parents during the implementation of USM during the 2021-2022 school year.

Design: This was a qualitative study using semi-structured interviews.

Participants/setting: Twenty-nine California FSDs selected through purposive sampling to ensure diversity in district size, urbanicity, and student eligibility for free or reduced-price meals participated. Interviews were conducted via Zoom in Spring 2022.

Analysis: Thematic analysis was performed with an immersion-crystallization approach.

Results: FSDs perceived multiple benefits of USM, including increased meal participation, reduced stigma around free meals, and strong support for USM from parents and school communities. They believed consistent access to meals improved learning readiness and behavior. Operationally, FSDs reported increased administrative efficiency and the elimination of student meal debt. However, higher meal demand led to increased workloads, compounded by staffing shortages, challenges in hiring and retention, and supply issues exacerbated by the pandemic. California's Kitchen Infrastructure and Training grants supported equipment upgrades. Despite challenges, FSDs were optimistic about the future of USM and expressed a strong desire for its continuation.

Conclusions: FSDs perceived USM as beneficial for improving meal access, reducing stigma, and enhancing administrative efficiency. However, sustaining these benefits requires addressing operational challenges through targeted support and investments. Future research should assess the long-term viability of USM and strategies for overcoming challenges outside the pandemic context.

Background: Malnutrition is prevalent across health care settings and has adverse outcomes for patients and the health system. However, some patients do not recall being informed about their malnutrition risk/diagnosis.

Objective: This meta-synthesis of qualitative studies aimed to identify and synthesize patient, carer, and health worker perceptions and understanding of the terminology used by health workers for malnutrition risk/malnutrition.

Methods: Four databases were searched (Medline, Cumulated Index in Nursing and Allied Health Literature, PsycINFO, and Embase) up until August 2023. Title, abstract, and full text screening were independently completed by 2 reviewers. The quality of the included studies was assessed using the Critical Appraisal Skills Programme Qualitative Studies Checklist. Data were analyzed by the review team using thematic synthesis. The resulting themes informed review findings. The confidence in each finding was assessed using GRADE-Confidence in the Evidence from Reviews of Qualitative Research.

Results: Seventeen studies were included, contributing perspectives from patients (n = 7 studies), health workers (n = 5 studies), or both patients and health workers (n = 5 studies); no studies included carer perspectives. There were 5 themes: patients have differing understanding, interpretation of, and identification with, malnutrition risk and malnutrition terminology (very low confidence); health workers perceive that patients do not identify with or understand malnutrition risk and malnutrition terminology (low confidence); Patients do not routinely perceive their malnutrition risk or malnutrition diagnosis as problematic (low confidence); health workers use varied terminology for malnutrition risk and malnutrition (low confidence); and action is required to improve malnutrition diagnostic communication (low confidence).

Conclusions: Findings highlighted disparity in patients' perspectives regarding the terms used for malnutrition risk and malnutrition. Varied terms were used by health workers, and patients did not often associate these terms with a health condition that required treatment. Health workers and patients called for action to improve the communication of malnutrition. To do this, further research exploring malnutrition terminology and the broader concept of malnutrition communication is required with patients, carers and health workers.

Background: Adequate water intake is associated with improved cognitive and physical performance, prevention of dental caries, and overweight and obesity. However, access to free drinking water in schools remains inadequate. Water First, a school-based intervention promoting water consumption, was shown effective in preventing overweight, yet its costs have not been quantified.

Objective: To evaluate the costs of Water First from the school's perspective over 1 academic year.

Design: Secondary analysis of a cluster-randomized clinical trial assessing the cost of Water First.

Participants and setting: Six public schools in the San Francisco Bay Area during the 2018-2019 academic year, with an average of 578 ± 69 students per school and 110 ± 2 fourth-grade students in intervention schools, and 508 ± 190 students per school and 101 ± 5 fourth-grade students in control schools.

Intervention: Schools were randomized to receive water dispensers and stations in cafeterias and high-traffic areas and a schoolwide water promotion campaign (school-level intervention). Fourth-grade students and teachers received reusable water bottles, lessons, and materials for school and home (class-level intervention).

Main outcome measures: Activities, resources, and the value needed to implement the school-level and classroom-level intervention were systematically captured over 1 academic year, including labor, materials, and utilities costs.

Statistical analysis: The intervention costs per school and per student were estimated by summing the component-specific costs. Results are presented for both school-level and classroom-level interventions in 2023 US dollars.

Results: The Water First intervention costs $20 per student for the school-level and $131 per student for the classroom-level intervention over 1 academic year. Accounting for the useful life of the installed water stations and dispensers beyond 1 year, the annualized cost of the school-level intervention was $11 per student.

Conclusions: These cost estimates provide useful insights for schools and stakeholders to plan and implement effective school-based interventions that promote access to drinking water.