The Diet Guidelines: 3 Diets (DG3D) study protocol of a behavioral teaching kitchen intervention for type-2 diabetes prevention among African American adults.

A 12-Week Randomized Intervention Comparing the Healthy US, Mediterranean, and Vegetarian Dietary Patterns of the US Dietary Guidelines for Changes in Body Weight, Hemoglobin A1c, Blood Pressure, and Dietary Quality among African American Adults

How does diet quality change after diagnosis with type 2 diabetes

Background: While health literacy has been shown to influence health outcomes, recent evidence suggests nearly 25% of African American (AA) adults have below basic health literacy compared to only 9% of White Americans. This disparity may contribute to poorer outcomes observed in AA adults with type 2 diabetes mellitus (T2DM). Therefore, the aim of this study was to assess the pathways for the relationship between health literacy and diabetes outcomes in AA adults with T2DM. Methods: Data from 277 AA adults with T2DM from the southeastern U.S. were analyzed. Path analysis was used to assess the direct and indirect relationships between health literacy (comprehension and numeracy) and self-care and between self-care and glycemic control (HbA1c). We hypothesized that health literacy would have both a direct and indirect effect on HbA1c via self-care behaviors (specific diet, general diet, exercise, blood sugar monitoring, foot care). Results: In the path analysis for comprehension, health literacy did not have a direct effect on HbA1c (p=0.247), but did have a direct effect on specific diet (β=-0.18; p=0.002), blood sugar monitoring (β =-0.21; p<0.0001), and foot care (β=-0.13; p=0.032) and an indirect effect on HbA1c through specific diet (β=-0.13; p=0.043) and blood sugar monitoring (β=-0.29; p<0.0001). In the path analysis for numeracy, health literacy had a direct effect on glycemic control (β=-0.12; p=0.047) and specific diet (β=-0.13; p=0.039), blood sugar monitoring (β=-0.14; p=0.019), and foot care (β=-0.12; p=0.048) and an indirect effect on HbA1c through specific diet (β=-0.13; p=0.042) and blood sugar monitoring (β=-0.29; p<0.0001). Conclusions: In this sample of AA adults with T2DM, only numeracy had a direct effect on glycemic control, whereas both comprehension and numeracy had direct effects on self-care behaviors. These findings suggest the need for greater emphasis on increased numeracy for interventions in AA adults with T2DM. Disclosure J.S. Williams: None. L.E. Egede: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K24DK093699, R01DK118038, R01DK120861)

Background Despite advances in cardiovascular (CV) care, African American adults experience worse CV disease (CVD) outcomes than White adults, warranting the investigation of CVD prediction biomarkers. Plasma ceramides are bioactive lipids that are biomarkers of adverse cardiovascular risk for both primary and secondary prevention. However, racial/ethnic differences in ceramide levels and their link to CV health (CVH) in African American adults remain underexplored. Purpose This study aimed to: 1) assess the association between ceramide scores and CVH and atherosclerotic CVD (ASCVD) risk among African American adults and 2) compare ceramide scores between African American and White adults. Methods Health surveys and ceramides measurements were conducted for African American and White adults, both recruited from population-based observational study cohorts. Ten-year pooled cohort risk ASCVD scores were calculated based on American College of Cardiology guidelines. CVH was assessed using Life’s Essential 8 (LE8) scores, as per American Heart Association rubrics. CV risk factors in the two cohorts were compared using Chi-squared tests. Linear regression and Pearson correlation assessed the association between ceramide, LE8, and ASCVD risk scores. Linear regression, adjusted for age and sex, compared ASCVD risk and ceramide scores between the two cohorts. Results In total, 58 African American (mean age [SD] 54.5 [11.9] years, 67.9% women) and 1103 White (mean age [SD] 64.5 [11.9] years, 52.1% women) adults were included (Table 1). Compared to White adults, African American adults had a higher prevalence of overweight/obesity (92.9% vs 33.6%; p<0.001), hypertension (69.6% vs 42.5%; p<0.001), diabetes (30.4% vs 12.2%; p<0.001), and hyperlipidaemia (42.9% vs 30.0%; p=0.03). No difference in mean ASCVD risk was observed between the African American (12.8% [SD 10.4]) and White (12.6% [SD 11.1]) cohorts (p= 0.91). African American adults had lower 18:0 (0.08 [0.03] vs 0.10 [0.04] μmol/L) and 24:1 (0.91 [0.31] vs 1.17 [0.33] μmol/L) ceramides compared to White adults (p<0.001). Ceramide scores among African American adults were not associated with LE8 scores (p=0.077) or ASCVD risk scores (r=-0.12, p=0.428). Adjusting for age and sex, African American adults had lower ceramide scores compared to White adults (mean [SD] 1.90 [1.97] vs 3.48 [2.88], p=0.006). Conclusions In our study comparing African American and White adults in the community, the association observed between ceramide scores and CVH or ASCVD risk scores in the African American cohort did not reach statistical significance. Interestingly, despite a more suboptimal cardiometabolic profile, African American adults had lower ceramide scores compared to White adults. Our findings suggest that ceramide profiles may not accurately reflect cardiovascular risk in African American adults, warranting further exploration of alternative sphingolipid biomarkers of risk for this population.

A healthy plant-based diet was associated with slower cognitive decline in African American older adults: a biracial community-based cohort

We piloted a 6-month, church-based, behavioral intervention, Delta Body and Soul (DBS), for African American (AA) adults in the Lower Mississippi Delta (LMD). DBS was designed to improve overall dietary quality in LMD AA adults. The intervention included six once monthly group-based educational sessions implemented by trained church members. Program implementation, session attendance, congregational feedback, and baseline and post-intervention, demographic, health, behavioral, and clinical parameters were assessed. Participants were predominately AA, female, and overweight or obese. Retention rate was 79 %. High adherence, defined as attendance at four or more educational sessions, was associated with dietary quality improvement and reduced blood glucose. Implementation of the DBS pilot intervention was feasible and may result in dietary quality and clinical improvements.

Diet Quality Is Low and Differs by Sex in People with HIV

The majority of adult diets in the United States do not meet recommendations for consumption of whole grains (3), putting these individuals at increased risk for diet-related chronic diseases (10). Poor diet quality, inadequate consumption of whole grains, and chronic diseases are particularly prevalent in the impoverished rural South (1,7,9,12). Hence, dietary interventions designed to address nutrition inadequacies and thereby improve diet quality could lower chronic disease prevalence in this region of the country. Assessing a population’s diet quality is a necessary step for determining nutrition inadequacies and subsequently designing effective dietary interventions that address these problems. The Healthy Eating Index–2005 (HEI-2005) is a tool that assesses diet quality in terms of adherence to the 2005 Dietary Guidelines for Americans (DGA). Whole grains are among the 2005 and 2010 DGA key recommendations for food groups to encourage (10,11). However, little research has been conducted to determine the potential impact of whole grain for refined grain substitutions on diet quality. Hence, the objective of this study was to use simulation modeling to determine the effects of substituting familiar, more healthful whole grain foods for less healthy, refined grain foods on diet quality and total energy intake in lower Mississippi Delta (LMD) adults. Analyses were performed using data from the Foods of Our Delta Study (FOODS), a cross-sectional telephone survey of residents in a 36-county LMD region that was conducted from January to June 2000 (2). Dietary intake data were collected using the U.S. Department of Agriculture’s (USDA) 24-hour dietary recall multiple pass methodology with the assistance of a foods measurement guide that had been mailed to study participants. Dietary intake data were collected for 1,751 adults (18 years of age and older) using a single 24-hour recall. However, only plausible (500 ≤ intake kcal ≤ 6,000) 24-hour recalls were used for this study (13). The HEI-2005, a scoring method designed to measure adherence to the 2005 DGA (5), was used to measure diet quality. Briefly, the HEI-2005 is composed of 12 components corresponding to total fruit, whole fruit, total vegetables, dark green and orange vegetables and legumes, total grains, whole grains, milk, meat and beans, oils, saturated fat, sodium, and kcal from solid fats, alcoholic beverages, and added sugars (SoFAAS). The total score, calculated as the sum of the component scores, has a maximum value of 100. For each component, higher scores reflect better adherence to DGA recommendations corresponding to that component. All foods selected as substitutions were deemed familiar foods based on their inclusion in the FOODS data set. White breads, rolls, biscuits, and spaghetti were replaced with their whole wheat counterparts, and white rice was replaced with brown rice. To simulate the effects of substituting 25, 50, and 100% of targeted foods with their replacements on HEI-2005 total and component scores, the targeted items’ nutrient profiles were reduced by the respective amounts for the analyses and the replacement items’ nutrient profiles were inserted at the corresponding level. The nutrient profiles for the replacement foods were extracted from the FOODS data set. All statistical analyses were performed using SAS software (version 9.2, SAS Institute) and SUDAAN software (version 10.0.1, Research Triangle Institute). SAS survey and SUDAAN procedures were used to compute frequencies, means, and their associated 95% confidence intervals. These procedures are tailored to account for the complex sampling design used in FOODS. Hence, the results are weighted and should be considered representative of the LMD adult population. The population ratio method was used to compute mean HEI-2005 scores and corresponding 95% confidence intervals using jackknife variances for the overall population. It is the least biased way to estimate a mean HEI-2005 score for a population (4). Sixty-two of the 1,751 LMD respondents were excluded due to implausible dietary records, resulting in a total sample size of 1,689 adults. The sample was composed of 48% males, 43% African Americans, 21% < 30 years of age, and 23% ≥ 60 years of age. Approximately one-fourth (23%) of the sample’s household income was under $15,000 per year and 23% of the sample had less than a high school education. Almost one-fourth (24%) of the respondents were current smokers and 18% were former smokers. Based on self-reported heights and weights, 67% of the sample was either overweight (25.0 ≤ BMI ≤ 29.9) or obese (BMI ≥ 40.0). The mean daily energy intake for the LMD adult respondents was 2,010 kcal. 1 Corresponding author. USDA Agricultural Research Service. E-mail: jessica.thomson@ars.usda.gov. 2 Department of Medicine, University of Illinois at Chicago. Affiliated with USDA Agricultural Research Service at the time this work was completed.

To assess the dietary quality of older women with and without rheumatoid arthritis (RA) using the Healthy Eating Index-2005 (HEI-2005) to identify potential strategies to improve the nutritional status. Cross-sectional. Diet was assessed using 7 d food records and analysed for nutrient composition (Food Processor v. 7.11). Diet quality was determined using the HEI-2005, a measure of compliance with 2005 US Dietary Guidelines. Individuals with RA completed a self-reported evaluation of arthritis (pain scale and disability index). Independent two-tailed t tests or Mann-Whitney tests compared the differences between groups and correlations were computed between HEI-2005 and measures of disease reactivity. Arizona, USA. Older (> or = 55 years) women (n 108) with RA (n 52) and healthy controls (HC; n 56). There were no differences between groups in age, weight, or BMI (kg/m2). HC participants had higher mean HEI-2005 scores for whole fruit (cups; P = 0.02), total fruit (cups; P = 0.05), whole grains (oz; P = 0.004), oil (g; P = 0.05) and total HEI score (P = 0.04) than the RA group. In the RA group, these same HEI components were inversely correlated with disability index (r = -0.20, P = 0.04). Participants with RA reported lower mean intakes of carbohydrate (g; P = 0.02), fibre (g; P = 0.01) and vitamin C (mg; P = 0.04). This is the first study examining the dietary quality in older women with and without RA using the HEI-2005. Living with RA was associated with significantly lower dietary quality. Since even small changes in dietary quality can translate into better nutritional status, future interventions should focus on increasing dietary quality in this high-risk group.

Despite its overall decline in the United States, trends in cigarette smoking could vary by intersection with demographic characteristics. We explored trends in education-related disparities in current smoking among U.S. adults by race (Black or African American and White), sex, and U.S. census region. Data were from U.S. civilian non-institutionalized adults (aged ≥18 years) who self-identified as Black or African American and White and participated in the 1995-2019 Tobacco Use Supplement to the Current Population Survey. We estimated average annual percent changes in current cigarette smoking by the intersections of race, sex, census region, and educational attainment. We calculated educated-related prevalence differences in current cigarette smoking by subtracting the prevalence of bachelor's degrees from that of <high school in 1995-1996 and 2018-2019, then examined their variations by the intersection of sex, race, and region. Weighted multivariable logistic regression models were used to test education*survey year interactions across sexes, races, and regions. Education-related disparities in current cigarette smoking increased over time, especially among Black or African American male (PD1995-1996 = 22.8%; PD2018-2019 = 27.2%) and female adults (PD1995-1996 = 12.1%; PD2018-2019 = 16.5%). By region, Black or African American male adults in the Midwest showed the largest increase in education-related current cigarette smoking disparities, followed by Black or African American male and female adults in the South, and White male and female adults in the Midwest. These findings were because of small to no declines in the prevalence of current cigarette smoking among those with <high school education. The gap in the prevalence of current cigarette smoking by education widened over time, especially among Black or African American adults in certain regions. Despite the decline in the prevalence of current cigarette smoking in the U.S. population overall, such public health gain may not benefit all individuals equally. Using the data from a U.S. representative serial cross-sectional survey study during 1995-2019, we found that disparities in current cigarette smoking prevalence between those with <high school versus bachelor's degree education widened especially among Black or African American adults. Future research to investigate the barriers to progress among Black or African American adults with <high school education could inform interventions to reduce racial and education-related cigarette smoking disparities.

Similar changes in diet quality indices, but not nutrients, among African American participants randomized to follow one of the three dietary patterns of the US Dietary Guidelines: A secondary analysis

Background: The United States Dietary Guidelines (USDG) form the basis of federal nutrition programs/policies for Americans. There has been little work to ensure that the presentation of the USDG are culturally acceptable and relevant for African Americans (AAs). This study aimed to explore the acceptability and perceptions of a randomized intervention among AA adults adhering to unmodified dietary patterns outlined in the USDG (Healthy US, Mediterranean, Vegetarian). Methods: Qualitative focus groups were conducted with participants from a USDG-based intervention, the Dietary Guidelines: 3 Diets study (DG3D). Six focus group discussions were conducted with AA adults in the Southeastern US in December 2021, after completion of the 12-week DG3D intervention. Verbatim transcripts were coded thematically and analyzed in Nvivo12 using an iterative constant comparative method. Results: Participants (n = 42; median age 52 years, range 26–65, 16 Healthy US, 17 Mediterranean, 9 Vegetarian) shared their perspectives and experiences adopting USDG dietary patterns and reported barriers and facilitators to adopting dietary change. Discussions elicited insights into the cultural relevance of the USDG and dietary intervention. Participants also described their recommended changes to the USDG-based intervention to enhance program implementation and successful dietary change. Conclusions: Study findings suggest that adaptations to the USDG dietary patterns are needed to ensure cultural relevance for AA adults in the US. This study can inform the development of culturally relevant dietary guidelines and intervention programs.

Changes in Diet Quality over 10 Years Are Associated with Baseline Sociodemographic and Lifestyle Factors in the Multiethnic Cohort Study

Elevated Mortality Rates from Circulatory Disease in African American Men and Women of Los Angeles County, California—A Possible Genetic Susceptibility?

Poor Adherence to US Dietary Guidelines for Children and Adolescents in the National Health and Nutrition Examination Survey Population