Low-energy-density diets are associated with higher diet quality and higher diet costs in French adults

Low-energy-density diets are often recommended for weight control. Such diets have a higher nutrient content than do high-energy-density diets. This study tested the hypothesis that energy-dense diets have a relatively low monetary cost, whereas less energy-dense diets are more expensive. In this cross-sectional study, dietary intakes of 1,474 French adults (672 men, 802 women), aged 15 to 92 years, were assessed using 7-day diet records. Dietary energy density (kcal/g) was calculated by dividing total dietary energy by the edible weight of foods and caloric beverages consumed. Diet cost ($/7 days or $/2,000 kcal) was estimated using mean national food prices for 895 foods. The relationship between dietary energy density and diet cost was examined in a linear regression model. Within each quintile of energy intakes, the more energy-dense diets were associated with lower diet quality and with lower diet costs (r(2)=0.38 to 0.44). In a regression model, the more energy-dense diets cost less, whereas low-energy-density diets cost substantially more, adjusting for energy intakes, sex, and age. The finding that energy-dense diets cost less per 2,000 kcal may help explain why the highest rates of obesity are observed among groups of limited economic means. The finding that low-energy-density diets are associated with higher diet costs suggests that lasting improvements in diet quality may require economic as well as behavioral interventions.     

Factors associated with quality of life in older adults in the United States

Purpose  

According to the World Health Organization, quality of life (QOL) includes physical and mental health, emotional well-being, and social functioning. Using an adaptation of Andersen’s behavioral model, we examined the associations between the three dimensions of QOL and needs and health behaviors in a nationally representative sample of adults 65 years and older.     

Low energy density and high nutritional quality are each associated with higher diet costs in French adults

BACKGROUND: Low-energy-density diets are associated with higher diet costs per 10 MJ. Are diets of higher nutritional quality also associated with higher costs per 10 MJ? OBJECTIVE: The objective was to determine the relations between energy-adjusted diet costs, dietary energy density, and nutritional quality of diets. DESIGN: This was a cross-sectional study of a nationally representative sample of 1332 French adults in the 1999 Enquête Individuelle et Nationale sur les Consommations Alimentaires (INCA) data set. Analyses were based on data from 7-d food records. The monetary cost of each diet was estimated by using mean retail prices for 620 foods. Nutritional quality was estimated by calculating the mean adequacy ratio (MAR), based on 23 nutrients. Energy density was based on solid foods only. RESULTS: In a bivariate analysis, low-energy-density diets were of higher nutritional quality but also cost more. Participants in the highest tertile of MARs had the lowest dietary energy density and the highest diet costs, calculated both per day and per 10 MJ. In a multivariate model, dietary energy density was negatively linked to diet costs (euro/10 MJ), whereas MAR values were positively linked to diet costs after adjustment for age and energy intake. For a given energy intake and energy density, each 10% increase in MAR led to a 13% increase in estimated diet costs per 10 MJ. CONCLUSIONS: In this study of self-selected diets of French adults, lower energy density and higher nutritional quality were associated with higher energy-adjusted diet costs. Higher-quality diets cost more not only because they have a low energy density but also because they are nutrient rich.     

Factors associated with glucose tolerance in adults in the United States

Glucose tolerance data from the second National Health and Nutrition Examination Survey were analyzed to determine factors predicting fasting plasma glucose levels and glucose tolerance in a representative US population. Central adiposity (subscapular skinfolds), age, and family history of diabetes were the major predictors of fasting levels and of glucose tolerance. For women, having a diabetic mother was significantly related to fasting glucose and glucose tolerance, but for men the proportion of siblings with diabetes was positively related. Multiple regression analyses, after adjustment for age and subscapular skinfolds, identified white cell count, systolic blood pressure, natural logarithm total iron binding capacity, and family history variables as being significant predictors of glucose tolerance in both sexes. In addition, several other variables were predictive for men or women, but not for both. These data confirm the importance of the major predictors of glucose tolerance and suggest provocative new associations in the general population.     

Snacking is associated with overall diet quality among adults

Snacking occasions are considered to contribute little more than energy to the diet; however, few studies have examined the role of snacking on overall diet quality. The purpose of this study was to examine the association between snacking frequency and overall diet quality. This study included 11,209 adults aged 20 years and older who participated in the 1999-2004 National Health and Nutrition Examination Survey. Twenty-four-hour dietary recall data from the National Health and Nutrition Examination Survey 1999-2004 were used to assess snacking frequency and diet quality. Diet quality was assessed with the US Department of Agriculture's Healthy Eating Index-2005 (HEI-2005). To adjust for confounding variables, multiple linear regression models were used to estimate the association between snacking frequency and HEI-2005 score, whereas the relationship between snacking frequency and HEI-2005 component scores were examined with Tobit regression models. Contrary to expectation, snacking was modestly associated (P<0.001) with higher total HEI-2005 scores (49.3±0.5, 49.9±0.3, 50.9±0.3, 51.9±0.4, and 51.6±0.6 for snacking zero, one, two, three, and four or more times per day, respectively). Total fruit (P<0.001), whole fruit (P<0.001), whole grains (P<0.001), milk (P<0.001), oils (P<0.001), and sodium (P<0.001) component scores were positively associated with snacking frequency. Inverse associations between snacking frequency and total vegetables (P=0.009); meat and beans (P=0.045); and the energy from solid fat, alcohol, and added sugars (P=0.007) components were observed. Although the magnitude of the association between snacking and overall diet quality was modest, snacking was associated with a more nutrient-dense diet. Focusing on the contribution snacking may have on single nutrient intakes may overlook its total nutritional impact.     

Health-related quality of life among adults with work-related asthma in the United States

Purpose

The objective of this study was to examine health-related quality of life among adults with work-related asthma.

Methods

We analyzed 2006–2009 Behavioral Risk Factor Surveillance System Asthma Call-back Survey data for ever-employed adults with current asthma from 38 states and District of Columbia. Individuals with work-related asthma had been told by a doctor or other health professional that their asthma was related to any job they ever had. Health-related quality of life indicators included poor self-rated health, impaired physical health, impaired mental health, and activity limitation. We calculated prevalence ratios (PRs) adjusted for age, sex, race/ethnicity, education, income, employment, and health insurance.

Results

Of ever-employed adults with current asthma, an estimated 9.0 % had work-related asthma, 26.9 % had poor self-rated health, 20.6 % had impaired physical health, 18.2 % had impaired mental health, and 10.2 % had activity limitation. Individuals with work-related asthma were significantly more likely than those with non-work-related asthma to have poor self-rated health [PR, 1.45; 95 % confidence interval (CI), 1.31–1.60], impaired physical health (PR, 1.60; 95 % CI, 1.42–1.80), impaired mental health (PR, 1.55; 95 % CI, 1.34–1.80), and activity limitation (PR, 2.16; 95 % CI, 1.81–2.56).

Conclusions

Future research should examine opportunities to improve health-related quality of life among individuals with work-related asthma.     

Characteristics associated with the uptake of influenza vaccination among adults in the United States

Objective

Existing data suggest that influenza vaccination rates among adults in the United States fall far short of the Healthy People 2010 goals and the updated Healthy People 2020 targets. We identified characteristics associated with influenza vaccination that might inform strategies for increasing coverage.

Methods

We used data from the 2009 Behavioral Risk Factor Surveillance System to estimate adjusted prevalence ratios for receiving the influenza vaccine in the past 12 months.

Results

Among 134,101 adults aged ≥ 65 years, the influenza vaccination coverage level was 68.9%. Among 286,867 younger adults aged 18-64 years, coverage was markedly lower: 31.8%. Having health care coverage was the strongest predictor of vaccination in both age groups, after accounting for other sociodemographic characteristics, health behaviors, and health status. Those reporting older age, white race, higher education, non-smoking status, being physically active, or having poor physical health or a personal history of various chronic conditions were also more likely to report having received the influenza vaccine.

Conclusion

Our results show clearly that vaccine uptake in the United States is related to social position as well as other health behaviors. These findings call for renewed attention to vaccination strategies to meet the updated Healthy People 2020 goals.     

Improved program activities are associated with decreasing tuberculosis incidence in the United States

OBJECTIVE: This study was conducted to determine whether improvements in tuberculosis (TB) program activities correlate with incident TB cases. MMETHODS: National TB surveillance data and program data from patients with pulmonary and laryngeal TB and their contacts were collected. These data were analyzed using regression models to assess the association between changes in incident TB cases and indicators of program performance (a time series of percent changes in program indices). RRESULTS: A total of 1,361,113 contacts exposed to 150,668 TB patients were identified through contact investigations. From 1987 to 1992 (the period of TB resurgence and antedating increased funding), there was a decline in several measures used by TB programs for outcomes of contact investigations. From 1993 to 1998 (the period after increases in TB funds), there was an observable improvement in the program indices. Four program indices for contacts and two for TB cases (directly observed therapy and completion of therapy) were statistically associated (p < or = .01) with the decline in TB incident cases. CONCLUSIONS: These analyses suggest that expanded TB program activities resulted in the reduction in national TB cases and underscore the importance of treatment completion for TB disease and latent TB infection. Based on these results, we propose that further improvements in these activities will accelerate the decline of TB in the United States.     

Food preparation by young adults is associated with better diet quality

OBJECTIVE: To describe food-preparation behaviors, cooking skills, resources for preparing food, and associations with diet quality among young adults. DESIGN: Cross-sectional analyses were performed in a sample of young adults who responded to the second wave of a population-based longitudinal study. Measures pertaining to food preparation were self-reported and dietary intake was assessed by a food frequency questionnaire, both by a mailed survey. SUBJECTS/SETTING: Males (n = 764) and females (n = 946) ages 18 to 23 years. STATISTICAL ANALYSES PERFORMED: Cross-tabulations and chi2 tests were used to examine associations between food preparation, skills/resources for preparing foods, and characteristics of young adults. Mixed regression models were used to generate expected probabilities of meeting the Healthy People 2010 dietary objectives according to reported behaviors and skills/resources. RESULTS: Food-preparation behaviors were not performed by the majority of young adults even weekly. Sex (male), race (African American), and living situation (campus housing) were significantly related to less frequent food preparation. Lower perceived adequacy of skills and resources for food preparation was related to reported race (African American or Hispanic) and student status (part-time or not in school). The most common barrier to food preparation was lack of time, reported by 36% of young adults. Young adults who reported frequent food preparation reported less frequent fast-food use and were more likely to meet dietary objectives for fat (P < 0.001), calcium (P < 0.001), fruit (P < 0.001), vegetable (P < 0.001), and whole-grain (P = 0.003) consumption. CONCLUSIONS: To improve dietary intake, interventions among young adults should teach skills for preparing quick and healthful meals.     

Factors associated with sugar-sweetened beverage intake among United States high school students

This cross-sectional study examined associations of demographic characteristics, weight status, availability of school vending machines, and behavioral factors with sugar-sweetened beverage (SSB) intake, both overall and by type of SSB, among a nationally representative sample of high school students. The 2010 National Youth Physical Activity and Nutrition Study data for 11,209 students (grades 9-12) were used. SSB intake was based on intake of 4 nondiet beverages [soda, other (i.e., fruit-flavored drinks, sweetened coffee/tea drinks, or flavored milk), sports drinks, and energy drinks]. Nationwide, 64.9% of high school students drank SSB ≥1 time/d, 35.6% drank SSB ≥2 times/d, and 22.2% drank SSB ≥3 times/d. The most commonly consumed SSB was regular soda. Factors associated with a greater odds for high SSB intake (≥3 times/d) were male gender [OR = 1.66 (95% CI = 1.41,1.95); P < 0.05], being non-Hispanic black [OR = 1.87 (95% CI = 1.52, 2.29); P < 0.05], eating at fast-food restaurants 1-2 d/wk or eating there ≥3 d/wk [OR = 1.25 (95% CI = 1.05, 1.50); P < 0.05 and OR = 2.94 (95% CI = 2.31, 3.75); P < 0.05, respectively] and watching television >2 h/d [OR = 1.70 (95% CI = 1.44, 2.01); P < 0.05]. Non-Hispanic other/multiracial [OR = 0.67 (95% CI = 0.47, 0.95); P < 0.05] and being physically active ≥60 min/d on <5 d/wk were associated with a lower odds for high SSB intake [OR = 0.85 (95% CI = 0.76, 0.95); P < 0.05]. Weight status was not associated with SSB intake. Differences in predictors by type of SSB were small. Our findings of significant associations of high SSB intake with frequent fast-food restaurant use and sedentary behaviors may be used to tailor intervention efforts to reduce SSB intake among high-risk populations.     

Short and long sleep are positively associated with obesity,diabetes, hypertension,and cardiovascular disease among adults in the United States

Research associates short (and to a lesser extent long) sleep duration with obesity, diabetes, and cardiovascular disease; and although 7–8 h of sleep seems to confer the least health risk, these findings are often based on non-representative data. We hypothesize that short sleep (<7 h) and long sleep (>8 h) are positively associated with the risk of obesity, diabetes, hypertension, and cardiovascular disease; and analyze 2004–2005 US National Health Interview Survey data (n = 56,507 observations, adults 18–85) to test this. We employ multilevel logistic regression, simultaneously controlling for individual characteristics (e.g., ethnoracial group, gender, age, education), other health behaviors (e.g., exercise, smoking), family environment (e.g., income, size, education) and geographic context (e.g., census region). Our model correctly classified at least 76% of adults on each of the outcomes studied, and sleep duration was frequently more strongly associated with these health risks than other covariates. These findings suggest a 7–8 h sleep duration directly and indirectly reduces chronic disease risk.     

Persistent oral health problems associated with comorbidity and impaired diet quality in older adults

Chewing, swallowing, and mouth pain (CSP) are identified as indicators of nutritional risk in older adults. Previous research has shown that oral health problems in community-living older rural adults were associated with increased hospitalization. The purpose of this study was to characterize older adults with self-reported persistent CSP problems at baseline and one-year follow-up. Participants were from the Geisinger Rural Aging Study, either with persistent oral problems (PCSP; n=22) or without problems (NCSP; n=125). Demographic, health, and anthropometric data were collected via home visit; diet information was assessed by five, 24-hour recalls collected over 10 months. PCSP subjects reported almost twice the number of medications (4.2 vs 2.6, respectively, P=.008) and diseases (7.0 vs 4.2, respectively, P=.001), with higher occurrence of type 2 diabetes mellitus, peptic ulcers/gastritis, and angina. PCSP participants had lower Healthy Eating Index scores (66.6 vs 70.6, respectively, P=.04), significantly lower intakes of vitamin A, and higher prevalence of inadequate intakes of vitamins B-6 and A. These results indicate that impaired intake of certain foods and nutrients is associated with persistent oral health problems. Oral status is an important component of overall health and should be monitored for intervention.     

Growth and diet quality are associated with the attainment of walking in rural Guatemalan infants

The attainment of gross motor milestones is an important indicator of motor development in early life; however, little is known about factors affecting gross motor development in children from developing countries. The purpose of this study was to examine the relation of nutritional factors (physical growth and dietary intake) and morbidity during the first year of life to the age of walking without support. Multivariate regression models were used to analyze data collected prospectively between 1991 and 1999 in rural Guatemala. Attainment of children's gross motor milestones was assessed monthly by trained field workers using the 17-milestone Gross Motor Development Scale, morbidity was assessed by biweekly recall, and dietary intakes were measured at 9 and 12 mo of age using repeated 24-h dietary recalls. Median age of walking was 15 mo (range 10-24 mo; n = 174) with no differences by gender. Models were adjusted for birth order, gender, gestational age, maternal age and education, socioeconomic status, and community. Growth in length (-0.57 +/- 0.27 mo length for age Z-score; P = 0.04) and weight (-0.54 +/- 0.19 mo weight for age Z-score, P = 0.005) during the first year of life, rather than size at birth, predicted age of walking. Animal protein intake from complementary foods, while low (mean < 1 g/d) overall, was positively associated with earlier age of walking (P = 0.02). Morbidity during infancy was not associated with age of walking. These findings indicate the importance of prevention of postnatal growth retardation and improvement of diet quality for children's gross motor development.     

Outbreaks associated with recreational water in the United States

In this article, we review the causes of outbreaks associated with recreational water during 1971-2000. A bacterial or protozoan etiology was identified in three-quarters of the outbreaks; 23% of the outbreaks were of undetermined etiology. The most frequently identified agents were Cryptosporidium (15%), Pseudomonas (14%), Shigella (13%), Naegleria (11%), Giardia (6%), and toxigenic E. coli (6%). Outbreaks attributed to Shigella, E. coli O157:H7, and Naegleria were primarily associated with swimming in fresh waters such as lakes, ponds, and rivers. In contrast, outbreaks caused by Cryptosporidium and Giardia were primarily associated with treated water in swimming and wading pools. Important sources of contamination for both treated and untreated recreational waters were the bathers themselves. Contamination from sewage discharges and wild or domestic animals were also important sources for untreated waters. Contributing factors in swimming-pool outbreaks were inadequate attention to maintenance, operation, disinfection, and filtration. Although not all waterborne outbreaks are recognized nor reported, the national surveillance of these outbreaks has helped identify important sources of contamination of recreational waters and the etiologic agents. This information can affect prevention recommendations and research priorities that may lead to improved water quality guidelines.     

Trends in hospitalizations associated with gastroenteritis among adults in the United States, 1979-1995.

Gastroenteritis (GE) is among the most common illnesses of humans but the burden of disease, its epidemiology, and the distribution of pathogens in adults have not been fully examined. This information is needed to plan prevention strategies particularly for high-risk groups. This study is a retrospective analysis of data from the National Hospital Discharge Survey for the years 1979 through 1995 which describes the disease burden and epidemiology of hospitalizations associated with GE among adults in the United States. Diarrhoea was listed as a diagnosis on an average of 452,000 hospital discharges per year representing 1.5% of all hospitalizations among adults. The annual number of GE hospitalizations has decreased by 20% from approximately 500,000 in 1979 to 400,000 in 1995. The aetiology of 78% of cases coded as GE was undetermined. Until the aetiology of disease can be better established, specific strategies for prevention cannot be developed.     

Clinical and economic outcomes associated with respiratory syncytial virus vaccination in older adults in the United States

BackgroundRespiratory syncytial virus (RSV) is an important cause of lower respiratory infections and hospitalizations among older adults. We aimed to estimate the potential clinical benefits and economic value of RSV vaccination of older adults in the United States (US).MethodsWe developed an economic model using a decision-tree framework to capture outcomes associated with RSV infections in US adults aged ≥ 60 years occurring during one RSV season for a hypothetical vaccine versus no vaccine. Two co–base-case epidemiology sources were selected from a targeted review of the US literature: a landmark study capturing all RSV infections and a contemporary study reporting medically attended RSV that also distinguishes mild from moderate-to-severe disease. Both base-case analyses used recent data on mortality risk in the year after RSV hospitalizations. Direct medical costs and quality-adjusted life-years (QALYs) lost per case were obtained from the literature and publicly available sources. Model outcomes included the population-level clinical and economic RSV disease burden among older adults, potential vaccine-avoidable disease burden, and the potential value-based price of a vaccine from a third-party payer perspective.ResultsOur two base-case analyses estimated that a vaccine with 50% efficacy and coverage matching that of influenza vaccination would prevent 43,700–81,500 RSV hospitalizations and 8,000–14,900 RSV-attributable deaths per RSV season, resulting in 1,800–3,900 fewer QALYs lost and avoiding $557-$1,024 million. Value-based prices for the co–base-case analyses were $152-$299 per vaccination at a willingness to pay of $100,000/QALY gained. Sensitivity analyses found that the economic value of vaccination was most sensitive to RSV incidence and increased posthospitalization mortality risks.ConclusionsDespite variability and gaps in the epidemiology literature, this study highlights the potential value of RSV vaccination for older adults in the US. Our analysis provides contemporary estimates of the population-level RSV disease burden and insights into the economic value drivers for RSV vaccination.