Diet Quality and Fruit,Vegetable, and Sugar-Sweetened Beverage Consumption by Household Food Insecurity among 8- to 12-Year-Old Children during Summer Months

BackgroundSchool-delivered nutrition assistance programs have improved dietary intake for children from food-insecure households during the school year. However, little is known about their diet quality and eating patterns during summer months.ObjectiveSchool-aged children’s summer month weekday and weekend day diet quality and eating patterns were assessed by household food insecurity.DesignSecondary analysis of cross-sectional data was employed.Participants/settingDuring the summers of 2011 through 2017, baseline data were collected from parent–child dyads participating in one of two community-based obesity prevention trials in metropolitan Minnesota (N=218). The mean age of children was 10 years; 50% were girls, 49% were nonwhite, and 25% were from food-insecure households.Main outcome measuresChildren from food-secure and food-insecure households were identified by using the short form of the US Household Food Security Survey. Healthy Eating Index 2015 and eating patterns—including energy intake and consumption of whole fruits, vegetables, 100% fruit/vegetable juice, and sugar-sweetened beverages—were estimated by means of 24-hour dietary recall interviews conducted on weekdays and weekend days.Statistical analysis performedGeneral linear modeling was used to examine diet quality and eating patterns by food insecurity, controlling for child age, child body mass index z score, and parent education.ResultsChildren from food-insecure and food-secure households had Healthy Eating Index 2015 scores less than 50. Children from food-insecure households reported less energy intake, fewer cups of whole fruit, and more sugar-sweetened beverage consumption for every 1,000 kcal consumed on a weekend day when compared with their counterparts from food-secure households (P<0.05). Similar results were not seen for weekday eating patterns.ConclusionsWhole fruit and sugar-sweetened beverage consumption varied by food insecurity on weekend days during summer months. Because children tend to gain weight during summer months, efforts to increase weekend access to whole fruits and promote water consumption may contribute to weight gain prevention and healthy development, especially for children from food-insecure households.     

Food Insecurity Is Inversely Associated with Diet Quality of Lower-Income Adults

Food insecurity acts as a chronic stressor independent of poverty. Food-insecure adults may consume more highly palatable foods as a coping mechanism, leading to poorer diet quality and increased risks of chronic disease over time. Using data from the 1999-2008 National Health and Nutrition Examination Surveys, this study aimed to examine the cross-sectional differences in dietary intake and diet quality by household food security among 8,129 lower-income adults (≤300% of the federal poverty level). Food insecurity was assessed using the 18-item US Household Food Security Survey Module. Dietary intake was assessed from 24-hour recalls and diet quality was measured using the Healthy Eating Index-2005 and the Alternate Healthy Eating Index-2010. Relative mean differences in dietary outcomes by household food security were estimated using linear regression models, adjusting for sociodemographic characteristics. Lower-income food-insecure adults reported higher consumption of some highly palatable foods, including high-fat dairy products (P trend<0.0001) and salty snacks (P trend=0.01) compared with lower-income food-secure adults. Food insecurity was also associated with more sugar-sweetened beverages (P trend=0.003); more red/processed meat (P trend=0.005); more nuts, seeds, and legumes (P trend=0.0006); fewer vegetables (P trend<0.0001); and fewer sweets and bakery desserts (P trend=0.0002). No differences were observed for intakes of total energy and macronutrients. Food insecurity was significantly associated with lower Healthy Eating Index-2005 (P trend<0.0001) and Alternate Healthy Eating Index-2010 scores (P trend<0.0001). Despite no macronutrient differences, food insecurity was associated with characteristics of poor diet quality known to increase chronic disease risk.     

Relationships Among the Physical and Social Home Food Environments,Dietary Intake,and Diet Quality in Mothers and Children

BackgroundBoth the physical and social home food environment (HFE) are believed to influence dietary intake and diet quality, but few studies have examined both aspects together.ObjectiveThe purpose of this study was to examine the relationships among the physical and social HFE, dietary intake, and diet quality in mothers and children.DesignThis was a cross-sectional substudy of a larger study.Participants/settingThe study included 24 mothers (aged ≥30 years) with a biological child aged 6 to 12 years living in the Newark, DE, area between June and November 2018.Main outcome measuresThe outcome measures of interest included the physical HFE (ie, home food availability); aspects of the social HFE (ie, parenting styles, family meal frequency, and policies); maternal and child intake of fruits, vegetables, sugar-sweetened beverages, and snacks; and diet quality using the 2015 Healthy Eating Index total score.Statistical analysisPearson correlations were used to examine the relationship between physical HFE and dietary intake as well as social HFE and dietary intake in both mothers and children. The relationships were further examined through exploratory regression analyses.ResultsIn mothers, fruit availability in the physical HFE was correlated with fruit intake (r = 0.50; P = 0.02). Fruit and vegetable availability in the physical HFE were correlated with 2015 Healthy Eating Index total score in both the mother and child. Family meals participation was correlated with dietary intake (vegetable intake in children, r = 0.44; P = 0.04; and snack intake in mothers, r = –0.74; P < .001). Exploratory regression analysis showed vegetables in the HFE was associated with vegetable intake and 2015 Healthy Eating Index total score in mothers, and fruits and vegetables in the HFE were associated with child 2015 Healthy Eating Index total score. Family meals participation was negatively associated with maternal snack intake and child sugar-sweetened beverages intake. Authoritative parenting was negatively associated with child snack intake and permissive parenting was negatively associated with mother’s fruit intake.ConclusionsBoth the physical and social HFE are associated with maternal and child dietary intake, but only the physical HFE was associated with dietary quality. Although preliminary, these data indicate the importance of future studies that include measures to assess both the physical and social HFE to better elucidate the influences of the HFE on dietary intake.     

The 7-day Beverage Intake Questionnaire for Latino Children: Validation of a Culturally Tailored Tool

ObjectiveTo validate a culturally tailored 7-day beverage intake questionnaire for Latino children (BIQ-L).DesignCross-sectional.SettingFederally qualified health center in San Francisco, CA.ParticipantsLatino parents and their children aged 1–5 years (n = 105).Variables MeasuredParents completed the BIQ-L for each child and three 24-hour dietary recalls. Participants’ height and weight were measured.AnalysisCorrelations between the mean intake of beverages in 4 categories as determined by the BIQ-L and three 24-hour dietary recalls were assessed. Multivariable linear regression examined the association between sugar-sweetened beverages (SSB) servings as determined by the BIQ-L and child body mass index z-score.ResultsMean daily intake of SSB (r = 0.52, P < 0.001), 100% fruit juice (r = 0.45, P < 0.001), flavored milk (r = 0.7, P < 0.001), and unflavored milk (r = 0.7, P < 0.001) from the BIQ-L were correlated with intake assessed via three 24-hour dietary recalls. In the multivariable model, weekly servings of SSBs were associated with child body mass index z-score (β = 0.15, P = 0.02). Culturally specific beverages comprised 38% of the SSB intake reported on the BIQ-L.Conclusions and ImplicationsThe BIQ-L is a valid tool for assessing beverage intake among Latino children aged 1–5 years. The inclusion of culturally specific beverages is critical for accurately assessing beverage intake among Latino children.     

Evaluating a Food Pantry–Based Intervention to Improve Food Security,Dietary Intake,and Quality in Midwestern Food Pantries

BackgroundVoices for Food was a longitudinal community, food pantry–based intervention informed by the social ecological model, and designed to improve food security, dietary intake, and quality among clients, which was carried out in 24 rural food pantries across 6 Midwestern states.ObjectiveOur objective was to evaluate changes in adult food security, dietary intake, and quality from baseline (2014) to follow-up (2016), and to assess the role of adult food security on dietary outcomes.DesignA multistate, longitudinal, quasi-experimental intervention with matched treatment and comparison design was used to evaluate treatment vs comparison group changes over time and changes in both groups over time.Participants/settingAdult food pantry clients (n = 617) completed a demographic food security survey, and up to three 24-hour dietary recalls at baseline (n = 590) and follow-up (n = 160).InterventionCommunity coaching served as the experimental component, which only “treatment” communities received, and a food council guide and food pantry toolkit were provided to both “treatment” and matched “comparison” communities.Main outcome measuresChange in adult food security status, mean usual intakes of nutrients and food groups, and Healthy Eating Index-2010 scores were the main outcome measures.Statistical analyses performedLinear mixed models estimated changes in outcomes by intervention group and by adult food security status over time.ResultsImprovements in adult food security score (–0.7 ± 0.3; P = .01), Healthy Eating Index-2010 total score (4.2 ± 1.1; P < .0001), and empty calories component score (3.4 ± 0.5; P <.0001) from baseline to follow-up were observed in treatment and comparison groups, but no statistically significant changes were found for adult food security status, dietary quality, and usual intakes of nutrients and food groups between the 2 groups over time. The intervention effect on dietary quality and usual intake changes over time by adult food security status were also not observed.ConclusionsFood pantry clients in treatment and comparison groups had higher food security and dietary quality at the follow-up evaluation of the Voices for Food intervention trial compared with baseline, despite the lack of difference among the groups as a result of the experimental coaching component.     

Child Food Insecurity Is Associated with Energy Intake among Fourth- and Fifth-Grade Girls

BackgroundFood insecurity is associated with poor diet and obesity among adult women, but evidence among children is mixed, and few studies have examined differences between boys and girls.ObjectiveThis study examined the relationship between self-reported food insecurity and dietary intake among boys and girls.DesignCross-sectional survey data were used from the Children’s PowerPlay! Campaign evaluation.Participants and settingIn all, 3,547 fourth- and fifth-grade students (9 to 11 years old) from 44 San Diego-area elementary schools in 2012 completed diary-assisted 24-hour recalls and a questionnaire that included five questions from the Child Food Security Assessment.Main outcome measuresIndividual dietary components (including total energy, nutrients, and sugar-sweetened beverages), Healthy Eating Index-2010 scores, and meal patterns (such as meal sizes and missed meals) were derived from 24-hour recalls.Statistical analysesMultivariable linear and logistic regression models were used to estimate the relationships between food insecurity and diet characteristics.ResultsGirls with the highest food insecurity consumed 135 total kilocalories (P<0.005) and 60 snack kilocalories (P<0.05) more per day than girls with no food insecurity. These relationships were absent among boys.ConclusionsFood insecurity among girls in grades 4 and 5 was associated with higher energy intake. Findings support the need for further research to better understand the nature of this relationship and its implications for energy balance.     

Federal Food Program Participation and Beverage Intake Among Families With Low Household Income

ObjectiveExamine beverage intake among families with low income by household participation in federal food assistance programs.DesignCross-sectional study conducted in fall/winter 2020 via an online survey.ParticipantsMothers of young children insured by Medicaid at the time of the child's birth (N = 493).Variables MeasuredMothers reported household federal food assistance program participation, later categorized as Supplementation Nutrition Program for Women, Infants, and Children (WIC) only, Supplemental Nutrition Assistance Program-Education (SNAP) only, both WIC and SNAP, and neither. Mothers reported beverage intake for themselves and their children aged 1–4 years.AnalysisNegative binomial and ordinal logistic regression.ResultsAfter accounting for sociodemographic differences between groups, mothers from households participating in WIC and SNAP consumed sugar-sweetened beverages (incidence rate ratio, 1.63; 95% confidence interval [CI], 1.14–2.30; P = 0.007) and bottled water (odds ratio, 1.76; 95% CI, 1.05–2.96; P = 0.03) more frequently than mothers from households in neither program. Children from households participating in WIC and SNAP also consumed soda (incidence rate ratio, 6.07; 95% CI, 1.80–20.45; P = 0.004) more frequently than children in either program. Few differences in intake were observed for mothers or children participating in only WIC or SNAP vs both programs or neither program.Conclusion and ImplicationsHouseholds participating in both WIC and SNAP may benefit from additional policy and programmatic interventions to limit sugar-sweetened beverage intake and reduce spending on bottled water.     

Disparities in Access to Healthy Diets: How Food Security and Food Shopping Behaviors Relate to Fruit and Vegetable Intake

BackgroundFood shopping behaviors may help determine how local food environments influence fruit and vegetable (F/V) intake, especially among food insecure households.ObjectiveTo examine whether household food security, food access, and food shopping behaviors are associated with F/V intake among residents of a low-income neighborhood.DesignStudy design is cross-sectional.Participants/settingA simple random sample of 451 adults from a low-income neighborhood in Montreal (Canada) were recruited through telephone interviews in 2014. Final analyses included 417 participants.Main outcome measuresValidated assessment tools were applied to measure F/V intake and to distinguish food secure (FS) from food insecure (FI) participants. Neighborhood food access was calculated according to number of food stores within 0.5 miles of road network buffer of participants’ homes. Self-reported food shopping behaviors included trip frequency, store types, and transport used to reach the 3 most frequented stores. Participants also reported on mobility constraints, use of F/V markets, gardening, and perceived access to healthy food.Statistical analysesF/V intake was modeled using multivariable linear regression.ResultsA sample of adults, of whom 21.3% were living in FI households, reported consuming F/V an average of 4.1 times daily. FI participants had a lower intake of F/V (b = −0.69, P = .04), independent of sociodemographics, food access, resource constraints, perceived access to healthy food, and food shopping behaviors. Participants with mobility constraints had lower F/V intake (b = −0.68, P = .02), while gardening was associated with higher F/V intake (b = 0.59, P = .01). Number of supermarkets (b = −0.06, P = .03) and specialty stores (b = 0.10, P = .04) were associated with F/V intake, although the strength of the association was weak.ConclusionsFor FI households, barriers to food access linked to financial challenges are associated with lower intake of F/V. Studies on food environment should include people’s experience of food access to better understand the numerous barriers to F/V consumption faced by FI households.     

The Association Between Food Insecurity and Dietary Outcomes in University Students: A Systematic Review

BackgroundUniversity students may experience a high prevalence of food insecurity. The impacts of food insecurity on dietary intake and meal patterns of students have not been fully researched.ObjectiveThis systematic review aimed to examine the association between food insecurity and dietary outcomes among university students.MethodsNine electronic databases and gray literature were searched from their inception to July 2020. Studies that reported dietary outcomes in both food-secure and -insecure students or the association between food insecurity and dietary outcomes among current students in tertiary education settings in any country were included. All study designs were eligible for inclusion, except qualitative studies. Two reviewers completed the screening, data extraction, and quality assessment independently. Study quality was assessed using the Joanna Briggs Institute appraisal tools.ResultsSixteen studies were included in the final qualitative synthesis of this review. Most studies were cross-sectional designs and of fair quality. The prevalence of food insecurity among university students ranged from 21% to 82% across studies. Lower intakes of healthy foods (eg, fruits, vegetables, and whole grains) and higher intakes of unhealthy foods (eg, fast foods, added sugars, and sugar-sweetened beverages) were observed in food-insecure students, and studies with the most representative samples of the student body found these trends. Some food-insecure students consumed breakfast and evening meals less frequently than food-secure students but the evidence was limited. Validated food security and dietary assessment tools were inconsistently used to assess diet quality among students with differing food security status. The heterogeneity of student sampling and data collection may contribute to inconsistent findings.ConclusionPoorer dietary outcomes were found in university students with food insecurity compared with food-secure students, but statistical significance was only observed in a small number of studies. Future longitudinal studies using food security and dietary assessment tools validated in this population are recommended to confirm the observed associations between food insecurity and diet quality among university students.     

Select Food Group Intake of US Children Aged 2 to 4 Years by WIC Participation Status and Income

BackgroundFood group and nutrient priorities for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Food Package IV for children aged 2 to 4 years were described in the 2017 review of the WIC Food Package. Research has evaluated priority nutrient intake, but priority food group intake remains unknown.ObjectivesTo compare mean intake of priority food groups/subgroups of WIC children to WIC-eligible nonparticipants and higher income children. Further, we hoped to assess differences in percent contribution of food subgroups to total food group intake by WIC participation status and income.DesignCross-sectional study conducted using data from the 2011-14 National Health and Nutrition Examination Survey.Participants/settingOne thousand forty-seven children aged 2 to 4 years.Main outcome measuresMean intake reported in cup equivalents and ounce equivalents. We also looked at mean percent that food subgroups contributed to total intake within a food group. Analyses were performed for high and low priority food groups/subgroups: high = seafood, total vegetables, dark green vegetables, red/orange vegetables, whole grains, and nuts/seeds/soy; low = total starchy vegetables, other vegetables, legumes computed as vegetables, total dairy, and total protein foods.Statistical analyses performedMultivariable linear regression analysis was used evaluate the relationship between income/WIC participation and mean intake/percent food subgroups contributed to total food group intake.ResultsAmong low-income WIC-eligible children, participation in WIC was associated with greater mean intake of red/orange vegetables (0.18 ± 0.03 vs 0.01 ± 0.06 c equivalents; P < 0.05) and legumes (0.07 ± 0.01 vs 0.01 ± 0.02 c equivalents; P < 0.01). No differences in mean intake were observed between WIC children and higher income children. Grain intake of WIC children was composed of a higher percentage of whole grains (19.1% ± 1.6% vs 13.2% ± 1.5%; P < 0.01) compared with higher income children. The percent vegetable subgroups contributed to total vegetable intake varied by income; no differences were observed for dairy or protein subgroups.ConclusionsAmong low-income children, participation in WIC was associated with greater intake of certain vegetables. Participation in WIC may also help close the diet quality gap between low-income and higher income children for priority foods targeted by the WIC food package. Future research should explore socioeconomic disparities in intake of nutrient-poor foods.     

Dietary Patterns and Osteoporosis Risk in Postmenopausal Korean Women

ObjectivesThe prevalence of osteoporosis and related fractures has increased rapidly in Korean women. Proper nutrition intake is associated with the prevention of osteoporosis. We analyzed the association between dietary patterns and the risk of osteoporosis during a 4-year follow-up in postmenopausal Korean women.MethodsPostmenopausal women (n = 1,725) who participated in the Korean Genome and Epidemiology Study were enrolled. Food intake was assessed using a validated semiquantitative food frequency questionnaire, and a quantitative ultrasound device was used to measure the speed of sound at the radius and tibia.ResultsThree major dietary patterns were identified using factor analysis based on baseline intake data: traditional (high intake of rice, kimchi, and vegetables), dairy (high intake of milk, dairy products, and green tea), and western (high intake of sugar, fat, and bread). Multivariate Cox proportional hazards models were used to estimate relative risk for osteoporosis. An inverse association was detected between the dairy dietary pattern and the osteoporosis incidence [relative risk (RR): 0.63, 95% confidence interval (CI): 0.42–0.93, p-trend = 0.055 in radius; RR: 0.56, 95% CI: 0.35–0.90, p-trend = 0.048 in tibia]. Individuals in the highest quintile for the traditional dietary pattern (p-trend = 0.009 in tibia) and western dietary pattern (p-trend = 0.043 in radius) demonstrated a higher risk of osteoporosis incidence than those in the lowest quintile.ConclusionThese results suggested that high consumption of milk, dairy products, and green tea may reduce the risk of osteoporosis in postmenopausal Korean women.     

Breakfast eating pattern and its association with dietary quality indices and anthropometric measurements in young women in Isfahan

ObjectiveTo assess the association between consuming or skipping breakfast and dietary quality indices such as the Healthy Eating Index (HEI), the Dietary Diversity Score (DDS), diversity scores of different food groups, and anthropometric measurements in young Isfahanian women.MethodsWomen 18 to 28 y old were selected randomly from among university students (n = 411) in Isfahan, Iran. A validated semiquantitative questionnaire was used to assess dietary intake. Five food groups of the Food Guide Pyramid were considered for calculating the DDS and diversity score of the food groups. Subjects were categorized based on consuming or skipping breakfast. The HEI was calculated based on 10 components including the five food groups, different fat and sodium intakes, and the DDS.ResultsBreakfast consumers versus skippers had higher scores for the HEI (66 ± 13 versus 47 ± 13, P = 0.001), the DDS (6.8 ± 1.2 versus 4.9 ± 0.7, P = 0.001), and the DDSs for fruits (1.3 ± 0.2 versus 0.9 ± 0.1, P = 0.001), vegetables (1.6 ± 0.2 versus 1.2 ± 0.1, P = 0.001), and whole grains (1.3 ± 0.2 versus 0.9 ± 0.1, P = 0.001). Also, eating breakfast was associated with lower values for dietary energy density (0.96 ± 0.25 versus 1.04 ± 0.40, P = 0.01), the body mass index (20.0 ± 1.8 versus 23.3 ± 2.7, P = 0.001), and waist circumference (69.2 ± 7.6 versus 72.5 ± 8.7, P = 0.001). There was a higher prevalence of breakfast consumers in the third tertiles of the HEI and DDS. However, there was a smaller percentage of breakfast consumers in the third tertiles of the body mass index and waist circumference.ConclusionsBreakfast consumption was associated with higher scores of the dietary quality indices and lower values for the body mass index and waist circumference in young Isfahanian women. Further studies should be performed to determine the relation between the kind of breakfast consumed and the dietary quality indices.     

Comparison of School vs Home Breakfast Consumption with Cardiometabolic and Dietary Parameters in Low-Income,Multiracial/Ethnic Elementary School-Aged Children

BackgroundBreakfast consumption is often associated with improving cardiometabolic parameters and diet quality. However, literature evaluating breakfast consumption with these outcomes between the school and home environments is limited.ObjectiveThis study examined relationships between breakfast consumption locations (school vs home) and cardiometabolic parameters, breakfast dietary intake, and daily dietary intake.DesignThis cross-sectional study used baseline data from TX Sprouts, a 1-year school-based gardening, nutrition, and cooking cluster-randomized trial, implemented in 16 elementary schools in Austin, TX, during 2016 to 2019.Participants/settingAnalyses included 383 low-income, multiracial/ethnic elementary school-aged children (mean age = 9.2 years; 60.6% Hispanic; 70.5% free/reduced lunch; 58.5% home breakfast consumers).Main outcome measuresCardiometabolic parameters were obtained via fasting blood draws, and dietary intake was assessed using one 24-hour dietary recall conducted on a random, unannounced weekday. Cardiometabolic and dietary parameters (ie, energy intake, macronutrients, and food group servings) for breakfast and for the day were evaluated.Statistical analyses performedMultivariate analysis of covariance was performed to examine cardiometabolic parameters and dietary intake between school and home breakfasts.ResultsSchool breakfast consumers (SBC) had lower fasting triglyceride levels than home breakfast consumers (HBC) (89.0 mg/dL vs 95.7 mg/dL; P = 0.03) (to convert to mmol/L, multiply by 0.0113). SBC had lower total fat for the day (P = 0.02) and lower total and saturated fat, sodium, and refined grains at breakfast (P ≤ 0.01) than HBC. However, SBC had lower protein at breakfast (P = 0.01) and higher carbohydrates, total sugar, and added sugar for the day and at breakfast (P ≤ 0.03) than HBC.ConclusionsSBC compared with HBC had lower fat intake, which may have contributed to the lower triglyceride level observed in SBC, but also had lower protein intake at breakfast and higher added sugar intake for the day and at breakfast. These results suggest dietary intake differed between HBC and SBC; that is, the home and school environments, but more research is needed to evaluate if such differences are due to School Breakfast Program guidelines.     

Family Food Insecurity,Food Acquisition,and Eating Behavior Over 6 Months Into the COVID-19 Pandemic

ObjectivesDescribe coronavirus disease 2019 (COVID-19)-related employment and food acquisition changes for food-secure and food-insecure households. Examine associations between food insecurity, parent food acquisition, and child eating.MethodsA nationally representative cross-sectional survey with parents (N = 1,000) in Fall 2020. Measures included sociodemographics, food retail regulations, food insecurity, frequency of meals, changes in parent employment, food preparation, and food acquisition because of COVID-19.ResultsParents that reported recent food insecurity were more likely to report COVID-19-related employment changes (eg, job loss, reduced hours) and food acquisition changes. Food insecurity was modestly associated with more frequent in-person restaurant dining (B = 0.12, t(999) = 4.02, P < 0.001), more frequent restaurant delivery (B = 0.13, t(999) = 4.30, P < 0.001), less frequent homecooked meals (B = ?0.14, t(999) = 4.56, P < 0.001) but was not associated with take-out (B = 0.02, t(999) = 0.62, P = 0.54).Conclusions and ImplicationsFood insecurity was associated with employment changes, parent food acquisition, and children's consumption of homecooked and restaurant meals during COVID-19. Future work could explore resources that help parents acquire affordable, nutritious food.     

Association Between Sugar-Sweetened Beverage Intake and Mortality Risk in Women: The California Teachers Study

BackgroundThe evidence linking sugar-sweetened beverage (SSB) intake and mortality risk is conflicting, and associations between various SSB subtypes and mortality remain unclear.ObjectiveTo examine the association between baseline SSB intake, subtypes of SSB intake, and mortality risk in women.DesignProspective cohort study.Participants/settingParticipants of the California Teachers Study (n = 100,314; median age = 53 years) free of cardiovascular disease, cancer, and diabetes at baseline (1995-1996) were followed from 1995 to 2015. Baseline SSB intake was defined as caloric soft drinks (regular soft drinks, not diet soda), sweetened bottled waters or teas, and fruit drinks; and was derived from a self-administered food frequency questionnaire.Main outcome measureMortality was ascertained via annual linkage with state- and nationwide mortality records and the National Death Index over 20 years.Statistical analysisMultivariable-adjusted Cox proportional hazards models were used to generate hazard ratios (HRs) and 95% CIs for assessing associations between SSB intake and mortality. Rare/never consumers were the comparator group.ResultsThere were a total of 14,143 deaths over 20 years (30.5% from cardiovascular disease; 29.2% from cancer). In women who consumed ≥ 7 servings/week of SSBs at baseline (4% of participants), the multivariable-adjusted HRs were not significant for all-cause, cardiovascular disease-specific, or cancer-specific mortality. Consuming ≥ 7 servings/week of baseline caloric soft drink was associated with a higher risk of all-cause (HR = 1.26, 95% CI 1.10 to 1.46; P for trend = 0.02) and cancer-specific (HR = 1.33, 95% CI 1.08 to 1.63; P for trend = 0.08) mortality. In secondary analyses, consuming ≥ 1.5 c/day of baseline SSBs was associated with all-cause mortality (HR = 1.12, 95% CI 1.02 to 1.24; P for trend = 0.01).ConclusionsAlthough the baseline frequency of total SSB intake was not significantly associated with mortality, consuming ≥ 7 servings/week of caloric soft drinks was associated with higher risk of all-cause and cancer-specific mortality. Findings support public health efforts to reduce caloric soft drink consumption.     

Native Youth Participating in the Together on Diabetes 12-Month Home-Visiting Program Reported Improvements in Alternative Healthy Eating Index-2010 Diet Quality Domains Likely to Be Associated With Blood Pressure and Glycemic Control

BackgroundThe Together on Diabetes (TOD) intervention was a home-visiting diabetes prevention and management program for Native youth.Objectives(1) Examine the impact of the TOD program on diet quality using the Alternative Healthy Eating Index (AHEI-2010); (2) determine association between diet quality and cardiometabolic health.DesignThe TOD program was conducted from October 2012 to June 2014 and was evaluated using a pretest-posttest study design from baseline to 12 months. Dietary intake was assessed using a food frequency questionnaire.Participants/settingThere were 240 participants between 10 and 19 years of age from 4 reservation-based, rural tribal communities in the southwestern United States that had been diagnosed with T2DM or prediabetes or were identified as at risk based on body mass index and a qualifying laboratory test.InterventionYouth were taught a 12-lesson curriculum on goal setting, nutrition, and life skills education.Main outcome measuresBehavioral and physiologic outcomes related to diabetes.Statistical analysisChanges in AHEI-2010 score and associations with cardiometabolic measures were tested, over time, using adjusted longitudinal linear mixed-effects models.ResultsThe study sample reported an average energy intake of 2016 kcal/d (±1260) and AHEI-2010 score of 47.4 (±7.4) (range: 0-110, higher = better diet quality), indicating low diet quality at baseline. At 12 months’ follow-up, there was a reduction in kilocalories (mean = −346 kcal/d; P < .001), sugar-sweetened beverages (mean = −2 fluid oz/d; P = .032), red/processed meat (mean = −1.5 oz/d; P = .008), and sodium (mean = −650 mg/d; P < .001) but no change in AHEI-2010 score (P = .600). The change in systolic blood pressure from baseline to 12 months for participants within the highest AHEI-2010 quartile group was significantly larger than the change in participants within the lowest quartile group (mean = −5.90 mm Hg; P = .036).ConclusionsDespite stable AHEI-2010 scores during follow-up, there were improvements in diet quality domains likely to be associated with cardiometabolic health. Home-visiting programs like TOD are promising interventions for decreasing dietary intake of poor-quality foods.     

Children's Dietary Intake by Early Care and Education Setting in the US Affiliated Pacific

ObjectiveExamine differences in dietary intake of children aged 2–5 years in early care and education (ECE) setting in the US Affiliated Pacific (USAP).DesignSecondary analysis of cross-sectional data collected by the Children's Healthy Living program.ParticipantsChildren (n = 1,423) with complete dietary records and information on the ECE setting.Main Outcome MeasuresDietary intake by ECE setting; Head Start (HS), other ECE (OE), and no ECE.AnalysisComparison of mean dietary intake across ECE settings and multivariate logistic regression to evaluate ECE setting and likelihood for meeting dietary reference intake (DRI).ResultsChildren in HS and OE settings had a significantly higher intake of several food groups and nutrients, compared with no ECE; vegetables (0.4 cup-equivalents per thousand kcals [CETK] vs 0.3 CETK; P < 0.001), fruits (0.8 CETK vs 0.6 CETK; P = 0.001), milk (0.9 CETK for HS and 1.0 CETK for OE vs 0.8 CETK; P < 0.001). Sixty-five percent of the HS group met DRI and had greater odds of meeting calcium DRI (odds ratio, 1.8; 95% confidence interval, 1.2–2.7) compared with other groups. The OE group had the lowest proportion of children meeting recommended intakes for 19 out of 25 nutrients.Conclusions and ImplicationsMean intakes of foods and nutrients for children across the USAP meet some, but not all, recommendations and intakes vary across children attending various ECE setting types. Additional research on the clinical importance of these differences and the impact of the complex food systems in the USAP may identify systematic strategies for improving diet among children.     

Food Insecurity: Its Relationship to Dietary Intake and Body Weight among Somali Refugee Women in the United States

ObjectiveTo examine the association between food insecurity, dietary intake, and body mass index among Somali refugee women living in the United States.MethodsCross-sectional study utilizing the snowball sampling method.ResultsMost (67%) participants experienced some level of food insecurity, which was common among recent arrivals and those who spoke only Somali at home (P < .05). Intake of meat and eggs was higher, whereas intake of fruits and vegetables was lower, among food insecure than secure participants. Food insecurity was positively related to overweight and obesity (odds ratio: 2.66; confidence interval: 1.25-5.69; P < .01).Conclusions and ImplicationsSomali refugees experienced high levels of food insecurity upon resettlement. Poor dietary habits and the high overweight/obesity rate among insecure families call for future research in understanding what role family structure, cultural norms, and food preference play in predicting food security and dietary habits among Somali and overall African refugees in the United States.     

Changes in Food and Nutrient Intake and Diet Quality on a Low-Fat Vegan Diet Are Associated with Changes in Body Weight,Body Composition,and Insulin Sensitivity in Overweight Adults: A Randomized Clinical Trial

BackgroundConsuming different food groups and nutrients can have differential effects on body weight, body composition, and insulin sensitivity.ObjectiveThe aim was to identify how food group, nutrient intake, and diet quality change relative to usual-diet controls after 16 weeks on a low-fat vegan diet and what associations those changes have with changes in body weight, body composition, and measures of metabolic health.DesignSecondary analysis of a randomized clinical trial conducted between October 2016 and December 2018 in four replications.Participants/settingParticipants included in this analysis were 219 healthy, community-based adults in the Washington, DC, area, with a body mass index (BMI) between 28 and 40, who were randomly assigned to either follow a low-fat vegan diet or make no diet changes.InterventionA low-fat, vegan diet deriving approximately 10% of energy from fat, with weekly classes including dietary instruction, group discussion, and education on the health effects of plant-based nutrition. Control group participants continued their usual diets.Main outcome measuresChanges in food group intake, macronutrient and micronutrient intake, and dietary quality as measured by Alternate Healthy Eating Index-2010 (AHEI-2010), analyzed from 3-day diet records, and associations with changes in body weight, body composition, and insulin sensitivity were assessed.Statistical analyses performedA repeated-measure analysis of variance model that included the factors group, subject, and time was used to test the between-group differences throughout the 16-week study. Interaction between group and time was calculated for each variable. Within each diet group, paired comparison t tests were calculated to identify significant changes from baseline to 16 weeks. Spearman correlations were calculated for the relationship between changes in food group intake, nutrient intake, AHEI-2010 score, and changes in body weight, body composition, and insulin sensitivity. The relative contribution of food groups and nutrients to weight loss was evaluated using linear regression.ResultsFruit, vegetable, legume, meat alternative, and whole grain intake significantly increased in the vegan group. Intake of meat, fish, and poultry; dairy products; eggs; nuts and seeds; and added fats decreased. Decreased weight was most associated with increased intake of legumes (r = ?0.38; P < 0.0001) and decreased intake of total meat, fish, and poultry (r = +0.43; P < 0.0001). Those consuming a low-fat vegan diet also increased their intake of carbohydrates, fiber, and several micronutrients and decreased fat intake. Reduced fat intake was associated with reduced body weight (r = +0.15; P = 0.02) and, after adjustment for changes in BMI and energy intake, with reduced fat mass (r = +0.14; P = 0.04). The intervention group’s AHEI-2010 increased by 6.0 points on average, in contrast to no significant change in the control group (treatment effect, +7.2 [95% CI +3.7 to +10.7]; P < 0.001). Increase in AHEI-2010 correlated with reduction in body weight (r = 0.14; P = 0.04), fat mass (r = ?0.14; P = 0.03), and insulin resistance as measured by the Homeostasis Model Assessment (HOMA-IR; r = ?0.17; P = 0.02), after adjustment for changes in energy intake.ConclusionsWhen compared with participants’ usual diets, intake of plant foods increased, and consumption of animal foods, nuts and seeds, and added fats decreased on a low-fat vegan diet. Increased legume intake was the best single food group predictor of weight loss. Diet quality as measured by AHEI-2010 improved on the low-fat vegan diet, which was associated with improvements in weight and metabolic outcomes. These data suggest that increasing low-fat plant foods and minimizing high-fat and animal foods is associated with decreased body weight and fat loss, and that a low-fat vegan diet can improve measures of diet quality and metabolic health.