Guidelines For Americans Research Articles

Physical activity and incident cardiovascular disease in breast cancer survivors: the pathways study.

Breast cancer survivors experience higher rates of cardiovascular disease (CVD) than women without breast cancer, due in part to cardiotoxic cancer treatments and shared lifestyle risk factors. Physical activity is associated with lower mortality risk in breast cancer survivors, but associations with CVD have not been examined in detail. The Pathways Study is a prospective cohort study of 4,504 women diagnosed with invasive breast cancer between 2005 and 2013. At enrollment, women self-reported their physical activities during the previous six months, which were dichotomized as meeting the CDC's Physical Activity Guidelines for Americans (≥150 minutes of moderate-intensity or ≥ 75 minutes of vigorous-intensity activity per week) vs not. Incident CVD events (heart failure, cardiomyopathy, cardiac arrest, ischemic heart disease, stroke) occurring between enrollment and December 2021 were identified from electronic health records. Covariate-adjusted, competing risks Cox regression models estimated associations between meeting physical activity guidelines and CVD risk. Compared with women who did not meet physical activity guidelines at their diagnosis, those who did had a 25% lower risk of CVD (HR: 0.75, 95% CI: 0.60, 0.94). Among the individual CVD outcomes, meeting physical activity guidelines was protective against incident cardiomyopathy (HR: 0.54, 95% CI: 0.31, 0.95), heart failure (HR: 0.66, 95% CI: 0.50, 0.87), and cardiac arrest (HR: 0.68, 95% CI: 0.49, 0.99). Meeting physical activity guidelines at breast cancer diagnosis was associated with lower risk of CVD after diagnosis. Studies investigating changes in physical activity after a breast cancer diagnosis and CVD risk are warranted.

Analysis of Physical Activity Using Wearable Health Technology in US Adults Enrolled in the All of Us Research Program: Multiyear Observational Study.

To date, no studies have examined adherence to the 2018 Physical Activity Guidelines for Americans (PAGA) in real-world longitudinal settings using objectively measured activity monitoring data. This study addresses this gap by using commercial activity monitoring (Fitbit) data from the All of Us dataset. The primary objectives were to describe the prevalence of adherence to the 2018 PAGA and identify associated sociodemographic determinants. Additionally, we compared 3 distinct methods of processing physical activity (PA) data to estimate adherence to the 2008 PAGA. We used the National Institutes of Health's All of Us dataset, which contains minute-level Fitbit data for 13,947 US adults over a 7-year time span (2015-2022), to estimate adherence to PAGA. A published step-based method was used to estimate metabolic equivalents and assess adherence to the 2018 PAGA (ie, ≥150 minutes of moderate- to vigorous-intensity PA per week). We compared the step-based method, the heart rate-based method, and the proprietary Fitbit-developed algorithm to estimate adherence to the 2008 PAGA. The average overall adherence to the 2018 PAGA was 21.6% (3006/13,947; SE 0.4%). Factors associated with lower adherence in multivariate logistic regression analysis included female sex (relative to male sex; adjusted odds ratio [AOR] 0.66, 95% CI 0.60-0.72; P<.001); BMI of 25.0-29.9 kg/m2 (AOR 0.53, 95% CI 0.46-0.60; P<.001), 30-34.9 kg/m2 (AOR 0.30, 95% CI 0.25-0.36; P<.001), or ≥35 kg/m2 (AOR 0.13, 95% CI 0.10-0.16; P<.001; relative to a BMI of 18.5-24.9 kg/m2); being aged 30-39 years (AOR 0.66, 95% CI 0.56-0.77; P<.001), 40-49 years (AOR 0.79, 95% CI 0.68-0.93; P=.005), or ≥70 years (AOR 0.74, 95% CI 0.62-0.87; P<.001; relative to being 18-29 years); and non-Hispanic Black race or ethnicity (AOR 0.63, 95% CI 0.50-0.79; P<.001; relative to non-Hispanic White race or ethnicity). The Fitbit algorithm estimated that a larger percentage of the sample (10,307/13,947, 73.9%; 95% CI 71.2-76.6) adhered to the 2008 PAGA compared to the heart rate method estimate (4740/13,947, 34%; 95% CI 32.8-35.2) and the step-based method (1401/13,947, 10%; 95% CI 9.4-10.6). Our results show significant sociodemographic differences in PAGA adherence and notably different estimates of adherence depending on the algorithm used. These findings warrant the need to account for these disparities when implementing PA interventions and the need to establish an accurate and reliable method of using commercial accelerometers to examine PA, particularly as health care systems begin integrating wearable device data into patient health records.

Associations of Combined Physical Activity and Body Mass Index with Metabolic Syndrome in American Adults: From the National Health and Nutrition Examination Survey, 2017-2020.

The purpose of this study is to examine the combined associations of physical activity and body mass index with the prevalence of metabolic syndrome in a population-based sample of American adults. Cross-sectional study. Data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). A total of 2945 American adults who participated in the NHANES 2017-2020. Participants' physical activity levels were categorized based on the Physical Activity Guidelines for Americans. Metabolic syndrome was determined using the National Cholesterol Education Program Adult Treatment Panel III guidelines. The prevalence of metabolic syndrome among the various groups was analyzed using binary logistic regression to observe differences in the associated risks of developing metabolic syndrome. An increase in body mass index and a decrease in physical activity are both risk factors for metabolic syndrome. Statistical results show that the prevalence of metabolic syndrome in the obese and sedentary group is 22.31 times higher than that in the normal weight and active group (P = 0.000). A combination of at least 600 MET-minutes of physical activity per week and a lower body mass index is significantly associated with the lowest prevalence of metabolic syndrome.

Abstract 4136796: The effect of replacing typical snacks with pecans on vascular health and diet quality: a randomized controlled trial

Background: Poor diet quality accounts for approximately half of all deaths from cardiometabolic diseases. Food pattern modelling using nationally representative U.S. data suggests that replacing typical snacks consumed with tree nuts will improve diet quality. However, few clinical trials have assessed the potential for tree nuts to improve diet quality. Pecans are rich in polyphenols, which may improve endothelial and vascular function. This study aimed to examine how substitution of usual snack foods with 2 oz/day of pecans affects flow mediated dilation (FMD), carotid-femoral pulse wave velocity (cf-PWV), blood pressure and diet quality after 12 weeks in individuals at increased risk for cardiometabolic disease. Hypothesis: Intake of 2 oz/day of pecans in place of habitually consumed snacks will improve vascular health and diet quality compared to habitual intake. Methods: In this single-blind RCT, adults (46 ± 13 years, 29.8 ± 3.7 kg/m 2 ) with ≥1 criterion for metabolic syndrome who were free from cardiovascular disease, type 2 diabetes and other chronic diseases were included. The experimental group was provided with 2 oz/day of pre-portioned raw, unsalted pecans (~392 kcal) and instructed to replace the snacks they currently consume with the provided pecans. The control group was instructed to continue their usual diet. FMD (primary outcome), cf-PWV, brachial and central blood pressure were measured at baseline and following the intervention period (~12 weeks). At three timepoints (baseline, week 6, and week 12) during the study, participants completed three 24-hour recalls (total 9 recalls). The Healthy Eating Index-2020 (HEI-2020) was calculated to assess diet quality. Results: A total of 138 (69 per group) participants were randomized. No between-group difference in FMD, cf-PWV, or blood pressure was observed. The HEI-2020 was 11.1 points higher (95% CI 5.1, 17.2) in the pecan group compared to the usual diet group at week 12. The following HEI-2020 components were improved in the pecan group vs. the usual diet group: total protein foods (0.5 points [95% CI 0.1, 1.0]), seafood and plant proteins (2.5 points [95% CI 1.6, 3.4]), fatty acids (4.1 points [ 95% CI 2.6, 5.5]), and sodium (1.8 points [95% CI 0.3, 3.2]). Conclusion: Replacement of usual snacks with 2 oz of pecans improved adherence to the Dietary Guidelines for Americans but did not improve endothelial function, blood pressure, or arterial stiffening.

Exploring Protein Dietary Guidance Statements

Consumers may benefit from quick signals on or nearby food product to nudge them toward choosing healthier diets, such as Dietary Guidance Statements (DGSs) from the US Food and Drug Administration. It is unclear how DGSs on foods, including animal or plant proteins, impact purchase motivation, believability, or willingness to pay more. Six DGS claims were tested across 5 protein types (pork tenderloin, beef top sirloin fillet, chicken breast, turkey breast, and plant-based meat) using an online prediction market test survey format among 1002 nationally representative US-based household primary grocery shoppers aged 18 to 64 years. The most motivating and believable DGS across protein types was the Dietary Guidelines DGS: The Dietary Guidelines for Americans recommends eating 5½ oz of protein food per day as part of a nutritious dietary pattern. &lt;protein type&gt; is a lean meat that provides 3 oz of protein food per serving (based on a 2000-calorie diet). More than one-third felt that this Dietary Guidelines DGS was the most motivating and believable because it was informative; imparted feelings of the protein type being healthy; contained statistics, facts, or numbers; and mentioned the US Dietary Guidelines for Americans. More than 50% of participants were willing to pay at least 5% or more for the protein type specified in the Dietary Guidelines DGS across all protein types. Uniform adoption of DGSs across protein food groups allows for equal representation of how a variety of proteins can contribute to a nutritious dietary pattern.

Comprehensive Assessment of Adequate Nutrition in Children and Adults with Sickle Cell Disease As Determined By Dietary Guidelines for Americans

Comprehensive Assessment of Adequate Nutrition in Children and Adults with Sickle Cell Disease As Determined By Dietary Guidelines for Americans

A Review of Low- and No-Calorie Sweetener Safety and Weight Management Efficacy

Low- and no-calorie sweeteners (LNCSs) impart sweetness while providing little or no energy. Their safety and weight management efficacy remain unsettled science that leaves open questions among consumers, researchers, clinicians, and policy makers. The objective of this narrative review is to provide a critical consideration of the safety and efficacy of weight management evidence for LNCSs that have been reviewed/approved by the US Food and Drug Administration and have the highest frequency of use: acesulfame potassium, allulose, aspartame, erythritol, monk fruit, saccharin, stevia, sucralose, and xylitol. Safety assessments by the authoritative bodies for the World Health Organization, European Union, and United States were reviewed. Additionally, emerging topics of interest regarding the safety of these sweeteners commonly cited in the recent literature or highlighted in the media are discussed. Collectively, authoritative assessments and the primary literature support the safety of the sweeteners reviewed herein, with high concordance of safety substantiation across authoritative bodies. Weight management efficacy, measured by various adiposity indices in epidemiological studies, ranges from no effect to a slight positive association. Clinical trials with various mixtures of LNCSs more consistently indicate LNCS use is associated with lower adiposity indices. The latter are ascribed greater evidentiary weight, and recent application of statistical methods to better correct for potential biases in cohort studies reveals they are more consistent with the clinical trial findings. Studies that investigated individual sweeteners were limited but suggestive of differing effects or lack of sufficient data to support any formal conclusions on their efficacy for weight management. Taken together, and consistent with the current 2020-2025 Dietary Guidelines for Americans, the evidence indicates LNCS use is safe and may aid weight management.

The development and testing of a single-arm feasibility and acceptability study of a whole foods diet intervention for adults with prediabetes and their offspring

BackgroundDiet is considered a first-line treatment option for prediabetes, a condition that affects 96 million United States (U.S.) adults. Diet patterns that prioritize whole foods (e.g., Mediterranean) are currently recommended to treat prediabetes. However, no studies have tested whether a U.S.-style diet pattern that prioritizes whole foods can be used to treat prediabetes. The purpose of this study was to assess the feasibility and acceptability of a whole foods diet for adults with prediabetes and their offspring prior to conducting a larger clinical trial.MethodsA 2-week single-arm pre-post experimental controlled-feeding intervention of a 2020–2025 Dietary Guidelines for Americans adapted whole foods diet (e.g., primarily focused on foods that have undergone limited processing or refinement) was conducted in adults (25–59 years) with prediabetes and their biological offspring (6–17 years). Families received 2 weeks of menus and grocery delivery and weekly counseling by a registered dietitian. Families were invited to attend an optional focus group session. Feasibility was based on having a ≥ 50% family completion rate with ≥ 80% completion of study outcomes. Measures included adult–child anthropometrics (weight [kg], body mass index [BMI] including BMI% and Z-scores for offspring, waist circumference [cm]) and child diet quality estimated using the 2015 Healthy Eating Index (HEI) from a single random food record. Wilcoxon signed rank was used to compare differences between baseline and 2-week anthropometrics measures and offspring total HEI scores. Qualitative data were analyzed using thematic analysis to understand factors attributed to diet adherence and acceptability.ResultsEight families enrolled (n = 8 adults, n = 12 offspring), with 7 families completing the study (12% attrition) and completing 100% of study outcome measures. Adults experienced a median weight loss of − 1.0 kg from baseline to 2 weeks (79.5 kg to 78.5 kg). Offspring had a 24-point increase in total 2015 HEI scores (median difference 50 to 74). Focus group participants (n = 4 adults) reported being satisfied with the program and expressed a willingness to continue the diet despite identified barriers.ConclusionsA whole foods diet that provides dietary support was found to be feasible and acceptable for families at risk for T2D. Future studies are needed to test the effects of the diet on prediabetes outcomes, diet quality, and diet adherence in adults and families.Trial registrationNCT05483972 at ClinicalTrials.gov. Registered July 25, 2022. https://clinicaltrials.gov/study/NCT05483972?cond=prediabetes&term=whole%20foods%20&rank=1

Dietary Intake and Diet Quality of Female and Male NCAA Division I Cross Country Runners from a Single University

BackgroundCollegiate student-athletes have unique nutritional requirements to support their athletic performance and health. Few studies have comprehensively characterized the diets of National Collegiate Athletic Association (NCAA) Division I student-athletes. ObjectivesTo characterize dietary intake and diet quality during a competitive season in female and male NCAA Division I cross country student-athletes from a single university. MethodsFemales and males (n = 14/sex) from the Florida State University cross country teams completed 9-d of food records across their competitive season. Nutrient intakes were compared to the Dietary Reference Intakes for the United States population [e.g., Recommended Daily Allowances (RDAs)] and athlete-specific guidelines. Diet quality was assessed according to the Dietary Guidelines for Americans (DGAs) using the 2020 Healthy Eating Index (HEI-2020). Total daily energy expenditure was estimated from training records. ResultsCarbohydrate intakes were below athlete guidelines in 43% of females (mean ± SD, 5.67 ± 1.16 g·kg–1·d–1) and 29% of males (4.95 ± 1.05, P sex = 0.096). All participants met or exceeded athlete recommendations for protein (2.09 ± 0.425 g·kg–1·d–1, 1.92 ± 0.519, P sex = 0.36) and fat (32.8 ± 5.1% kcal, 34.4 ± 3.4%, P sex = 0.36). No participants met the RDA for vitamin D (5.14 ± 1.78 μg/d, 4.91 ± 3.24, P sex = 0.83). Only 79% of females and 36% of males met the RDA for calcium (1220 ± 307 mg/d, 1010 ± 296, P sex = 0.83). Most females (n = 13) and males (n = 11) consumed iron supplements where total intakes exceeded the tolerable upper intake level (110 ± 60.1 mg/d, 66.8 ± 36.3, P sex = 0.029). HEI-2020 indicated poor adherence to the DGAs, with better diet quality in females (65.3 ± 13.7) than males (50.6 ± 10.1, P sex = 0.0034). Participants failed to meet guidelines for all HEI-2020 food group components except total protein foods. Total daily energy expenditure was greater in males and declined across the competitive season (P sex < 0.0001, P time < 0.0001, P sex∗time = 0.25). ConclusionsNCAA Division I cross country student-athletes consumed inadequate carbohydrates, calcium, and vitamin D but met or exceeded intake guidelines for protein, fat, and iron. Diet quality was poor; HEI-2020 component scores may indicate food groups to target to improve diet quality and intake of nutrients important to runners.This trial was registered at clinicaltrials.gov as NCT04079322.

Dietary modulation of human milk bioactives is associated with maternal FUT2 secretor phenotype: an exploratory analysis of carotenoids and polyphenol metabolites.

Maternal diet modifies profiles of human milk oligosaccharides (HMOs), carotenoids, and polyphenols in human milk (HM). However, substantial variability in profiles exists between women, highlighting the complexity of non-dietary factors modulating these profiles. The objective of this study was to carry out a secondary analysis exploring the effect of maternal diet on HM carotenoids and polyphenols and relationships between dietary modulation of HM bioactives (carotenoids, polyphenols, and oligosaccharides) and maternal α1,2-fucosyltransferase 2 (FUT2) secretor phenotype. In this pilot study, 16 exclusively breastfeeding women with obesity were enrolled between 4 and 5 months postpartum. The women were provided a 4-week meal plan consistent with the 2020 Dietary Guidelines for Americans (DGA). HM was collected for 24 h at baseline and post-intervention. Maternal FUT2 secretor phenotype was determined by 2'-fucosyllactose concentration in HM (non-secretor: < 100 nmol/ml; secretor: ≥100 nmol/ml). Concentrations of carotenoids and HMOs were determined by LC and polyphenol metabolites by UPLC-MS/MS. Thirteen women completed the study (6 secretors, 7 non-secretors). The change in HM concentrations of the HMOs lacto-N-tetraose (LNT, p = 0.007), lacto-N-fucopentaose II (LNFP II, p = 0.02), difucosyllacto-N-tetraose (DFLNT, p = 0.003), and disialyllacto-N-tetraose (DSLNT, p = 0.003) and polyphenol metabolites 4-hydroxybenzoic acid (4-HBA, p = 0.08) and ferulic acid (p = 0.02) over the intervention time frame was differentially associated with maternal secretor status. 4-HBA and ferulic acid positively correlated with HMOs LNT and DSLNT (rrm = 0.82-0.90, p = 0.03-0.06) for secretors but not for non-secretors. Only secretors demonstrated a negative correlation between 4-HBA and DFLNT (rrm = -0.94, p = 0.001). The influence of maternal diet on composition of HMOs and polyphenol metabolites in HM differs based on maternal secretor status. Consideration of non-dietary factors is needed to evaluate differences in response of HM bioactives to dietary modulation.

Assessment of dietary intake in patients with metabolic dysfunction-associated steatotic liver disease using the Ukrainian version of the EPIC-Norfolk Food Frequency Questionnaire: A cross-sectional study

Metabolic dysfunction‑associated steatotic liver disease (MASLD) is prevalent worldwide. Studies demonstrate a possible association between diet and MASLD. However, data regarding patients in Ukraine are lacking. Objective — to study dietary habits and meeting recommended dietary intake in patients with MASLD. Materials and methods. Adults with MASLD aged 18 years and older (n=29) receiving care in outpatient settings who fully completed the adapted and validated Ukrainian version of the EPIC‑Norfolk Food Frequency Questionnaire (FFQ) were included in the analysis. Liver steatosis was confirmed by ultrasound examination, and diagnosis of MASLD was based on the criteria defined by the American Association for the Study of Liver Diseases. As a reference for recommended dietary intake, data from the Dietary Guidelines for Americans, 2020—2025 years were used. FETA software was used to calculate nutrient data from the FFQ. The one‑sample t‑test, t‑test, the one‑sample signed rank sum test, and Mann‑Whitney test were used to assess the differences between the sample and the reference data. The chi‑squared test was used to analyse categorical data. Results. The mean age of participants was 41.4±12 years, 69% of participants being female. The mean body mass index was 35.4±7.9 kg/m2. Participants consumed more protein, than recommended by current dietary recommendations. Women also tended to have higher energy intake and consume more fat, saturated fatty acids, and carbohydrates than recommended. The median fibre intake was 19.36 g (Q1; Q3 : 13.29; 26.45), which is lower than the recommended 14 g per 1000 kcal (p=0.0015). Dietary intake of most vitamins and micronutrients was met. However, women and men consumed less than 600 IU of vitamin D daily. Among all patients with MASLD, sodium intake (3829.5±1559.3 mg) was significantly higher than recommended (2300 mg, p&lt;0.0001). Approximately 62% of participants take dietary supplements, with vitamin D being the most popular choice. Conclusions. Our study showed that patients with MASLD in Ukraine tend to exceed recommended protein and sodium intake and, at the same time, have low fibre and Vitamin D consumption. High energy intake and saturated fatty acids consumption are also of concern.

Using Less Processed Food to Mimic a Standard American Diet Does Not Improve Nutrient Value and May Result in a Shorter Shelf Life at a Higher Financial Cost

BackgroundThe “clean eating” trend suggests that consuming fewer processed foods is important for healthy diets. Yet, a diet of mostly ultra-processed foods (UPFs) can meet recommendations from the Dietary Guidelines for Americans. Whether a diet comprised mostly of simple ingredient foods can provide a low-quality diet remains unexplored. ObjectivesThe objective of this study was to compare the diet quality, shelf stability, and cost of 2 similar nutrient-poor menus, one containing primarily UPFs and the other containing less-processed foods (LPW), as defined by the Nova classification system. MethodsA “Western” menu using LPW was developed to match the meals and recipes of a menu that contained more-processed foods (MPW). Processing level was determined using the Nova classification system. Final menus were assessed for nutrient quality and Healthy Eating Index (HEI) score. Shelf stability of foods/ingredients on both menus was determined from food storage guidance manuals. The condition of each food item when purchased (room temperature, frozen, refrigerated) was used to estimate the number of days until expiration. Food costs were determined from prices at grocery chains in Fall 2023. ResultsThe LPW had similar nutrient density and diet quality scores to the MPW (HEI scores of 44 and 43, respectively). The LPW included 20% energy (kcal) from UPFs, whereas the MPW included 67% energy from UPFs. Relative percentages of shelf-stable, frozen, and refrigerated foods were similar. Using the Kaplan-Meier survival analysis method, median time to expiration of the LPW menu items was 35 d compared with 120 d for the MPW items. The “per person” cost reflecting only the amount of the food used in the menu was $15.91/d for the LPW and $9.85/d for the MPW. ConclusionsLess-processed menus can have comparable diet quality with more-processed menus although being more costly and less shelf stable.

Initial implicit association between whole grains and taste does not predict consumption of whole grains in low-whole grain consumers: a pilot randomized controlled trial.

Health benefits of whole grain (WG) consumption are well documented. Current Dietary Guidelines for Americans recommend at least half of total grains consumed be WG; however, Americans consume less than one serving of WG per day. Inferior taste of whole grain products as compared with refined grain products has been reported as one of the main barriers to acceptability and consumption of whole grains. In this pilot study, we aimed to determine if mere exposure to WG foods in self-reported low WG consumers would improve their implicit associations between WG and pleasant taste. Healthy adults (n=45) were provided a variety of WG or refined grain (RG) products for home use for 6 weeks. Intake was measured by calculating disappearance and verified by a daily log. At the beginning and end of the intervention, we administered an Implicit Association Test (IAT), a computer test designed to measure indirectly the strength of association between pairs of concepts: (a) two contrasted target categories (WG and RG food images) and (b) two contrasted attribute categories (words relating to pleasant or unpleasant taste) via a classification task. Response time was used to calculate IAT D scores, indicating the strength of implicit associations between WG and RG and positive or negative taste. ANCOVA showed that average D scores at the end of the study shifted significantly toward a positive implicit association between WG and good taste (p<0.05) in participants whose baseline D scores indicated an initial preference for RG over WG. No significant differences were found between the WG and RG groups in overall consumption of provided grain products. These findings suggest that mere exposure to WG products over an extended period of time in a free-living situation can improve automatic attitudes toward WG, potentially leading to increased consumption of WG foods. Clinicaltrials.Gov, identifier NCT01403857.

Nutrient Intakes in Prostate Cancer Survivors in the United States: A Nationally Representative Study

There are currently more than 3.3 million prostate cancer (PC) survivors in the United States. Conformance with national dietary guidelines and a good diet quality may lower the risk for Gleason grade progression in PC patients. Assessing the nutritional status of PC survivors is thus of paramount importance from a public health nutrition perspective. We used 24-h dietary recall data from the National Health and Nutrition Examination Surveys (NHANES) to systematically estimate nutrient intakes in n = 360 PC survivors (which may be extrapolated to represent n = 1,841,030 PC survivors) aged 70.69 years on average, and contrasted the results to the daily nutritional goals (DNG) in the 2020–2025 Dietary Guidelines for Americans (DGA). Diet quality in PC survivors was found to be generally poor, and the DNG as specified in the DGA were not met for many micronutrients, including calcium, magnesium and potassium. PC survivors had an insufficient intake of many vitamins (including vitamins A, C, D and E), and did not meet the intake recommendations for dietary fiber. Racial disparities in PC were reflected in the lower overall DQ in Non-Hispanic Black participants. Our results reiterate the need for nutritional assessment and counseling to improve DQ in PC patients.

Nutritional Characteristics of Menus in State Prisons.

Nutrition-related health disparities plague prisons in the United States. Unregulated and inadequate prison menus may contribute to noncommunicable chronic health conditions in this vulnerable population. The purpose of this research was to assess nutrition offerings provided by prison menus. Researchers requested the most current version of all master menus and associated nutrition analyses for gendered and age-centric (pediatric vs geriatric) menus. Menu and nutrient data were extracted and entered into a spreadsheet for analysis. Prisons serve gendered or nongendered menus to the general population, and 52.9% of prisons offer nongendered menus where males and females receive the same meals. This approach provides excess calories and saturated fat to females. Sodium was served in excess to both males and females. Fruit and vegetable servings on all gendered menus fell short of recommendations. The average prison menu inappropriately offers calories, sodium, and fruit and vegetable servings in a one-size-fits-all menu development method without considering gender, age, and physical activity. Interpretation and application of Dietary Guidelines for Americans are inconsistent. Nutrition guidelines recommending appropriate nutrients and food groups should be developed and available to corrections systems and dietitians. Current prison menu development practices yield inappropriate nutrition for prison populations.

Implementing a Diet Risk Score (DRS) for Spanish-Speaking Adults in a Clinical Setting: A Feasibility Study.

Tools to briefly assess diet among US Spanish-speaking adults are needed to identify individuals at risk for cardiometabolic disease (CMD) related to diet. Two registered dietitian nutritionists (RDNs) recruited bilingual medical students to translate the validated Diet Risk Score (DRS) into Spanish (DRS-S). Participants were recruited from a federally qualified health center. Students administered the DRS-S and one 24-h recall (Automated Self-Administered 24-Hour (ASA24®) Dietary Assessment Tool) on one day; a second recall was administered within 1 week. Recalls were scored using the Healthy Eating Index (HEI)-2015, a measure of adherence to the Dietary Guidelines for Americans. Spearman correlations, weighted kappa, and ANOVA were conducted using SAS 9.4 to assess the relative validity of the DRS-S. Thirty-one Spanish-speaking adults (female: n = 17, 53%; mean age: 58 (42-69)) completed assessments. The mean DRS-S was 9 (SD = 4.2) (max: 27; higher score = higher risk) and the mean HEI-2015 score was 65.7 (SD = 9.7) (max: 100; higher score = lower risk), with significant agreement between measures (r: -0.45 (p = 0.01)), weighted kappa: -0.3 (p = 0.03). The DRS-S can be used in resource-constrained settings to assess diet for intervention and referral to RDNs. The DRS-S should be tested in clinical care to assess the impact of dietary changes to reduce CMD risk.

Perspective: Key Considerations When Developing and Publishing Dietary Interventions for Human Clinical Trials

A key guiding principle in the 2020–2025 Dietary Guidelines for Americans emphasizes the need for individuals to choose eating habits that allows for personal, cultural, and traditional preferences while establishing a high-quality diet. This concept becomes a daunting task given the need to reduce the consumption of foods higher in saturated fat, sodium, and/or added sugar—which are typically found in familiar, highly palatable foods most-often liked and consumed in the United States. Similarly, in nutrition intervention studies, adherence to healthier dietary patterns is typically low because of many factors, including reduced taste, flavor, and familiarity to the study foods. Increasing evidence illustrates the promising role of herbs and spices to maintain acceptability of healthier food options for nutrition interventions. This perspective article was informed by a Satellite Session presented at the American Society for Nutrition’s annual meeting, Nutrition 2023, entitled, “Developing Culturally Appropriate Recipes for Human Clinical Trials,” which explored several proposed best practice guidelines when developing nutrition interventions to improve dietary adherence and acceptability within clinical trials. The session also highlighted a need to include sufficient detail concerning the types and amounts of specific foods included within nutrition interventions in combination with preparation methods and study recipes, including herbs and spices, to improve intervention reproducibility and translatability for future research, dietary guidelines, and clinical practice.

Fat burning capacity in a mixed macronutrient meal protocol does not reflect metabolic flexibility in women who are overweight or obese.

Metabolic flexibility, the ability to switch from glucose to fat as a fuel source, is considered a marker of metabolic health. Higher fat oxidation is often associated with greater flexibility and insulin sensitivity, while lower fat oxidation is linked to metabolic inflexibility and insulin resistance. However, our study challenges the universal validity of this relationship, uncovering a more nuanced understanding of the complex interplay between fuel source switching and fat oxidation, especially in the presence of insulin resistance. In an 8-week controlled feeding intervention, overweight to obese women with insulin resistance (as defined by McAuley's index) were randomized to consume either a diet based on the Dietary Guidelines for Americans 2010 (DGA) or a 'Typical' American Diet (TAD), n = 22 each. Participants were given a high-fat mixed macronutrient challenge test (MMCT) (60% fat, 28% carbohydrates, and 12% protein) at weeks 0, 2, and 8. Plasma lipids, metabolome, and lipidome were measured at 0, 0.5, 3, and 6h postprandial (PP); substrate oxidation measures were also recorded at 0,1 3, and 6h PP. Metabolic flexibility was evaluated as the change in fat oxidation from fasting to PP. Mixed model and multivariate analyses were used to evaluate the effect of diet on these outcomes, and to identify variables of interest to metabolic flexibility. Intervention diets (DGA and TAD) did not differentially affect substrate oxidation or metabolic flexibility, and equivalence tests indicated that groups could be combined for subsequent analyses. Participants were classified into three groups based on the % of consumed MMCT fat was oxidized in the 6h post meal period at weeks 0, 2 and 8. Low fat burners (LB, n = 6, burned <30% of fat in MMCT) and high fat burners (HB, n = 7, burned > 40% of fat in MMCT) at all weeks. Compared to LB, HB group had higher fat mass, total mass, lean mass, BMI, lower HDLc and lower RER (p < 0.05), but not different % body fat or % lean mass. During week 0, at 1h PP, LB had an increase in % fat oxidation change from 0h compared to HB (p<0.05), suggesting higher metabolic flexibility. This difference disappeared later in the PP phase, and we did not detect this beyond week 0. Partial least squares discriminant analysis (PLSDA (regular and repeated measures (sPLSDA)) models identified that LB group, in the late PP phase, was associated with higher rates of disappearance of acylcarnitines (AC) and lysophosphatidylcholines (LPC) from plasma (Q2: 0.20, R2X: 0.177, R2Y: 0.716). In women with insulin resistance, a high fat burning capacity does not imply high metabolic flexibility, and not all women with insulin resistance are metabolically inflexible. LPCs and ACs are promising biomarkers of metabolic flexibility.

Seafood Consumption Trends among U.S. Consumers: Influences of the COVID-19 Pandemic.

The Dietary Guidelines for Americans (DGA) recommend twice-weekly consumption of seafood for health benefits, yet many U.S. consumers have historically fallen short of this target. The economic and societal impacts of the COVID-19 pandemic brought concern about further declines in seafood intake. This study evaluated the influence of COVID-19 on seafood intake among U.S. residents, toward understanding potential public health implications. A nationally representative cross-sectional survey of 1200 U.S. residents conducted in June 2021 evaluated the frequency and types of seafood consumed, and purchase methods used, before and during the early stages of the COVID-19 pandemic. The results (weighted data) indicate most U.S. consumers (90%) eat seafood, yet only 19% meet the seafood DGA. The likelihood of meeting the DGA was higher among consumers who were Asian, Black, or Hispanic; older; unmarried; of higher income; familiar with the DGA; choosing seafood for health reasons; and living in Atlantic or Gulf coast states. During COVID-19, some increased seafood intake for health reasons (45%), while others reduced intake due to factors such as cost (29%), limited availability (16%), and challenges with preparation (11%). Fresh salmon (68%), frozen shrimp (59%), and cooked oysters (41%) were most frequently purchased by consumers of these foods. More consumers indicated purchasing wild salmon (62%), shrimp (44%), and oysters (51%) than farm-raised products, though many were unsure. Fewer consumers included seafood in online grocery orders (36%) than meal kit orders (61%) when using these services. Though many consumers continued to eat seafood despite decreased restaurant patronage, most did not reach the intake level needed to maximize health benefits. Educational and marketing efforts promoting the health benefits of seafood and the convenience of procurement via online purchase methods may encourage intake across demographic groups to benefit public health outcomes in the U.S.

Periconceptional Dietary Quality and Metabolic Syndrome at 3 Years Postpartum.

The period around pregnancy is a critical window in the primordial prevention of cardiovascular disease, but little is known about the role of dietary patterns in cardiometabolic health. Our objective was to determine the association between alignment of periconceptional diet with the 2020 to 2025 Dietary Guidelines for Americans and the risk of metabolic syndrome. We used data from the Nulliparous Pregnancy Outcomes Study: monitoring mothers-to-Be Heart Health Study, a pregnancy cohort study that followed pregnant participants to a median of 3 years postpartum (n=4423). Usual dietary intake in the 3 months around conception was estimated from a Food Frequency Questionnaire. Alignment with the Dietary Guidelines was measured using the Healthy Eating Index-2020, where higher scores represent greater alignment. Postpartum metabolic syndrome was defined using the American Heart Association/National Heart, Lung, and Blood Institute guideline. The prevalence of metabolic syndrome at 3 years postpartum was 20%. After adjusting for confounders, the prevalence of metabolic syndrome was flat up to a periconceptional Healthy Eating Index-2020 total score of ≈60, and then declined steeply as scores increased. Compared with a Healthy Eating Index-2020 score of 60, having scores of 70, 80, and 90 were associated with 2, 4, and 7 fewer cases of metabolic syndrome per 100 individuals, respectively (prevalence differences: -0.02 [95% CI, -0.03, 0]; -0.04 [-0.08, -0.1]; -0.07 [-0.13, -0.02]). Dietary interventions around conception and systems-level changes to support high diet quality may be important for improving postpartum cardiometabolic health, and helping to reverse or slow the decline in women's cardiometabolic health.