Increasing Diet Quality Research Articles

Impact of Diet Modifications on Body Weight, Body Composition, Treatment Outcomes, and Quality of Life During Primary Treatment for Breast Cancer: A Systematic Review.

Breast cancer is a significant public health challenge, with 290 000 new cases annually and significant healthcare costs. Treatment advancements have led to improvements in survival, but common adverse effects include weight gain, fatigue, nausea, and taste changes, decreasing quality of life. This review aims to assess the impact of diet and lifestyle interventions during primary treatment for breast cancer and their effects on body weight, body composition, treatment-related adverse outcomes, and patient-reported quality of life. A search of PubMed, CINAHL, and EMBASE conducted through May 10, 2023, identified 31 publications describing 27 interventions including diet or diet plus exercise. The Cochrane Risk of Bias tool assessed the quality of publications. The findings suggest that whole foods, aerobic and strength-training exercises, and intermittent fasting during treatment may improve body weight and composition, treatment-related outcomes, and quality of life. Limitations include variation in study duration, small sample sizes, and limited sociodemographic data. Improvements seen with increased diet quality and reduced caloric intake, with or without exercise, challenge current standard-of-care recommendations during treatment for breast cancer. While there is a need for additional research, healthcare teams can confidently promote healthy diets and exercise during primary treatment for breast cancer to manage weight and improve treatment-related side effects and quality of life. PROSPERO registration no. 42023425613.

Comparison of snack characteristics by diet quality: findings from a nationally representative sample of Australian adolescents

Snacking is a common eating behaviour among adolescents accounting for more than a quarter of their total energy intake but the relationship between snacks and overall diet quality remains unclear(1). Hence, the aim of this study was to examine characteristics of snacks among Australian adolescents (12-18 years) according to their level of diet quality. This secondary analysis uses one day of 24-hour dietary recall data from the 2011 - 2012 National Nutrition and Physical Activity Survey (n = 935). Snacks were defined based on participant-identified eating occasions(2). The Dietary Guideline Index for Children and Adolescents (DGI-CA) was used to assessed adherence to the Australian Dietary Guidelines(3), with the highest tertile of the DGI-CA score indicating high adherence. The means (95% confidence intervals [CI]) for daily snack frequency and snack energy density (ED; kJ/g) were estimated for boys and girls, using linear regression, adjusted for age, area-level disadvantage, and energy misreporting. The differences in means and proportions across tertiles of DGI-CA scores were tested by using F- and Chi square-tests, respectively. The results show no significant differences in the mean frequency of snacks across tertiles of DGI-CA scores in either boys (lowest tertile mean = 2.2, 95% CI [2.0, 2.4] snacks/day, highest tertile = 2.1 [1.9, 2.3]) or girls (lowest tertile = 1.9 [1.7, 2.1] snacks/day, highest tertile = 2.2 [1.9, 2.4]). The mean ED of snacks decreased as DGI-CA scores increased in both boys (lowest tertile = 8.42, 95% CI [7.1, 10] kJ/g, highest tertile = 6.32 [5.4, 7.4] kJ/g) and girls (lowest tertile = 8.99 [7.8, 10.3] kJ/g, highest tertile = 5.92 [5.1, 6.9] kJ/g). As DGI-CA scores increased, the proportion of both boys and girls consuming discretionary foods at snacks (such as soft drinks) decreased, while foods from the five food groups (such as apples) increased (p-values < 0.05). In conclusion, snack ED, but not frequency, and the types of foods consumed by adolescents at snacks varied by a level of diet quality. Snack ED decreased with increasing diet quality and adolescents with higher diet quality had higher intakes of foods from the five food groups and lower intakes of discretionary foods at snacks. Encouraging the consumption of lower-ED foods from the five food groups at snacks presents an opportunity to enhance adolescent diet quality. Future studies should explore snack-specific strategies to improve overall diet quality of adolescents.

Perspectives on healthy eating practices and acceptance of WIC-approved foods among parents of young children enrolled in WIC.

The prevalence of childhood obesity remains high in the United States, particularly among children living in low-income households. Diet quality plays an important role in obesity prevention, particularly among mothers as they serve as role models. Those served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) receive nutrient-rich foods aimed at increasing diet quality, yet redemption is low. Digital interventions targeting WIC parents show potential for behavior change and could be used for childhood obesity prevention. This study describes the formative research conducted to understand perspectives on healthy eating practices, acceptance of WIC-approved foods, and preferences for the use of digital tools to improve the purchasing and consumption of WIC-approved foods to improve diet quality. In-depth interviews were conducted with 13 WIC parents and caregivers. A variety of definitions for and misconceptions about healthy eating exist among WIC caregivers. Most purchased foods were fruits, vegetables, milk, cheese, and eggs and the least purchased foods were yogurt and peanut butter. The biggest facilitator for purchasing WIC-approved foods was the preference of children and caregivers, whereas the biggest barrier was children's picky eating behaviors. Most caregivers reported using their phone to get nutrition information. Most caregivers reported their interest in receiving weekly text messages and indicated preferences about receiving recipes. A text messaging program that includes sending weekly messages, recipes, and nutrition tips is hypothesized to improve diet quality and increase redemption of WIC-approved foods.

Association of Changes in Neural Targets and Dietary Outcomes among Patients with Comorbid Obesity and Depression: Post hoc Analysis of ENGAGE-2 Mechanistic Clinical Trial

BackgroundDisruptions in brain circuits that regulate cognition and emotion can hinder dietary change and weight loss among individuals with obesity and depression. ObjectiveThe study aimed to investigate whether changes in brain targets in the cognitive control, negative affect, and positive affect circuits after 2-mo problem-solving therapy (PST) predict changes in dietary outcomes at 2 and 6 mo. MethodsAdults with obesity and depression from an academic health system were randomly assigned to receive PST (7-step problem-solving and behavioral activation strategies) over 2 mo or usual care. Seventy participants (mean age = 45.9 ± 11.6 y; 75.7% women, 55.7% Black, 17.1% Hispanic, 20.0% White; mean BMI = 36.5 ± 5.3 kg/m2; mean Patient Health Questionnaire-9 depression score = 12.7 ± 2.8) completed functional MRI and 24-h food recalls. Ordinary least square regression analyses were performed. ResultsAmong intervention participants, increased left dorsal lateral prefrontal cortex (dLPFC) activity of the cognitive control circuit at 2 mo was associated with increased diet quality (β: 0.20; 95% CI: −0.02, 0.42) and decreased calories (β: −0.19; 95% CI: −0.33, −0.04), fat levels (β: −0.22; 95% CI: −0.39, −0.06), and high-sugar food intake (β: −0.18; 95% CI: −0.37, 0.01) at 6 mo. For the negative affect circuit, increased right dLPFC–amygdala connectivity at 2 mo was associated with increased diet quality (β: 0.32; 95% CI: −0.93, 1.57) and fruit and vegetable intake (β: 0.38; 95% CI: −0.75, 1.50) and decreased calories (β: −0.37; 95% CI: −1.29, 0.54), fat levels (β: −0.37; 95% CI: −1.50, 0.76), sodium concentrations (β: −0.36; 95% CI: −1.32, 0.60), and alcohol intake (β: −0.71; 95% CI: −2.10, 0.68) at 2 but not at 6 mo. The usual care group showed opposing associations. The 95% CIs of all between-group differences did not overlap the null, suggesting a significant treatment effect. ConclusionsAmong adults with obesity and depression who underwent PST compared with those under usual care, improved dLPFC–amygdala regulation of negative affective brain states predicted dietary improvements at 2 mo, whereas improvements in dLPFC-based cognitive control predicted dietary improvements at 6 mo. These findings warrant confirmatory studies.This trial was at clinicaltrials.gov as NCT03841682.

Assessing patterns of change in lifestyle behaviours by parity: a longitudinal cohort study.

The time constraints and reprioritization of personal health associated with having children may lead women to adopt less healthy lifestyles. We assessed the patterns of change in weight and lifestyle behaviours associated with having children and whether these differ between primiparous and multiparous women. Data were from Surveys 3 and 5 of the 1973-1978 birth cohort of the Australian Longitudinal Study on Women's Health. In women who were nulliparous at Survey 3, we assessed changes in weight, energy intake, diet (diet quality, macronutrients and micronutrients), physical activity and sitting time by parity status at Survey 5 using one-way analysis of covariance. Of 4927 eligible women, 2503 gave birth (1090 primiparous and 1413 multiparous) by Survey 5. Women who had given birth 6 years later increased weight (1.0 kg; 95% CI 0.5, 1.5), energy intake (833.9 kJ/day; 95% CI 706.7, 961.1) and diet quality (1.5 units; 95%CI 0.8, 2.1), but decreased physical activity [-405.0 Metabolic Equivalent of Task.min/week; 95%CI -464.2, -345.8] and sitting time (-1.8 h/day; 95%CI -1.9, -1.6) (adjusted mean differences) relative to those who remained nulliparous. In subgroup analysis involving further stratification by parity, the increase in diet quality was only seen in women who became primiparous and the decrease in sitting time was more marked in multiparous women. Childbearing is associated with increased weight and energy intake, decreased physical activity, increased diet quality and decreased sitting time. More research targeting weight, energy intake and physical activity for improvement in women during the childbearing years is warranted.

Consumer strategies towards a more sustainable food system: insights from Switzerland

ABSTRACTBackgroundTo improve the sustainability performance of food systems, both consumption- and production-side changes are needed.ObjectivesTo this end, we assessed multiple sustainability impacts of 6 consumer strategies together with production-side aspects such as organic and circularity principles for Switzerland.MethodsTwo strategies encompassed dietary changes: following a pescetarian diet and adhering to the national dietary guidelines. Two strategies employed alternative farming systems: increasing the share of organic production and, in addition, applying the circularity principle of avoiding feed-food competition by limiting livestock feed to low-opportunity-cost biomass. A fifth strategy reduced food waste. The sixth strategy increased the share of domestic produce. For all strategies, we assessed greenhouse gas emissions, land use, nitrogen surplus, social risks, diet quality, and diet costs.ResultsThe strategies revealed trade-offs between impact categories, unless combined in a synergistic way. Whereas dietary changes towards more plant-based diets reduced environmental impacts (≤51%) and increased diet quality (≤57%), they increased social risks due to increased sourcing from contexts with potentially bad labor conditions (≤19%). Further, when the share of organic produce was increased, land use and dietary costs were increased (≤33% and ≤42%, respectively). The effect on land use could, however, be reversed when circularity principles were introduced in addition to the organic production standard, resulting in reductions for all environmental indicators (≤75%). Reducing food waste and increasing the share of domestic produce led to better sustainability performance as well, but at lower orders of magnitude.ConclusionsCombining all proposed strategies could lead to substantial favorable changes on all impact categories assessed, but would require a thorough transformation of the current food system. However, the sum of individual consumers each following only 1 of the strategies proposed would make an important contribution towards improving the sustainability performance of the Swiss food system.

Unhealthy diet in schizophrenia spectrum disorders.

The high mortality and prevalence of metabolic syndrome in patients with schizophrenia spectrum disorders (SSD) is maintained by poor diet. This narrative review summarizes recent literature to provide a reflection of current eating habits, dietary preferences, and nutritional status of SSD patients. Elucidating these factors provides new insights for potential lifestyle treatment strategies for SSD. Only 10.7% of the SSD patients had a healthy dietary pattern, against 23% of the general population. The dietic component of the Keeping the Body in Mind Xtend lifestyle program increased diet quality with 10% for young people with first-episode psychosis, compared to baseline, which was predominantly driven by increased vegetable variety and amounts. Recent findings render poor dietary habits as potential targets for treatment of SSD patients. Further studies into anti-inflammatory diets and associations with gut-brain biomarkers are warranted. When proven, structured and supervised diet interventions may help SSD patients escape from this entrapment, as only supplementing nutrients or providing dietary advice lacks the impact to significantly reduce the risk of chronic physical illnesses.

Abstract 12197: Rural Caregivers With Low Health Literacy Show Greater Improvements in Diet Quality From a Cardiovascular Disease Risk Reduction Intervention Designed to Address Low Health Literacy Than Those With High Health Literacy

Introduction: Rural caregivers of those with chronic illnesses have higher cardiovascular disease (CVD) risk than urban caregivers. Diet is a major lifestyle factor that contributes to CVD risk. We conducted a randomized controlled trial of a CVD risk reduction intervention called Rural Intervention for Caregivers’ Heart Health (RICHH), that was designed to promote CVD risk reduction, including healthy eating and that was designed to be accessible to those with low health literacy (HL). We tested the moderating effect of HL on the impact of the intervention on diet quality. Hypothesis: Rural caregivers with low HL would gain equal or greater benefits from the RICHH intervention on diet quality compared to those with high HL. Methods: The newest vital sign (NVS), rural-urban commuting area (RUCA) code ≥4 or living in Appalachian counties, and Healthy Eating Index-2015 (HEI-2015) were used to determine HL, rurality, and diet quality, respectively. The HEI-2015 was computed based on a food frequency questionnaire at baseline and post-intervention. The RICHH intervention was delivered using videoconference technology by nurse interventionists once a week for 12 weeks. A linear mixed effect model was used to evaluate the moderation effect of HL (NVS ≥ 4) on the impact of the intervention on diet quality. Results: A total of 296 rural caregivers (54.5 ± 13.7 years old, 76% female) completed the study. The improvement in HEI-2015 scores was greater in the low HL group than in the high HL group controlling for age and sex (beta estimate = 9.21, SE = 3.31, P = 0.0058). Conclusions: The RICHH intervention was effective in improving diet quality of rural caregivers compared to the control group. In particular, rural caregivers with low HL benefited more from the intervention aimed at increasing diet quality. Thus, addressing low HL could play an important role to improve diet quality and to reduce CVD risk among caregivers residing in rural environment.

Demographic and socio-economic shifts partly explain the Martinican nutrition transition: an analysis of 10-year health and dietary changes (2003-2013) using decomposition models.

The Caribbean has seen a dramatic shift in the obesity and chronic disease prevalence over the past decades, suggesting a nutrition transition. Simultaneously, Martinique has faced a demographic transition marked by significant population ageing. We aimed to differentiate the contribution of changes in health status and dietary intakes due to shifts in demographic and socio-economic characteristics (DSEC) from that due to unobserved factors. Two cross-sectional surveys conducted in 2003 (n 743) and 2013 (n 573) on representative samples were used. Dietary intakes were estimated by 24-h recalls. The contribution of changes in health status and dietary intakes due to shifts in observed DSEC was differentiated from that due to unobserved factors over a 10-year interval, using Oaxaca-Blinder decomposition models. Martinique, French region in the Caribbean. Martinican adults (≥16 years). Over the study period, health status deteriorated, partly owing to shifts in DSEC, explaining 62 % of the change in the prevalence of hypertension (+13 percentage points (pp)) and 48 % of waist circumference change (+3 cm). Diet quality decreased (mean adequacy ratio -2pp and mean excess ratio + 2 pp) and energy supplied by ultra-processed food increased (+4 pp). Shifts in DSEC marginally explained some changes in dietary intakes (e.g. increased diet quality), while the changes that remained unexplained were of opposite sign, with decreased diet quality, lower fruits, tubers and fish intakes and higher energy provided by ultra-processed foods. Explained dietary changes were of opposite sign to nutrition transition conceptual framework, probably because unobserved drivers are in play, such as food price trends or supermarkets spread.

66534 Evaluation plans for a summer child nutrition assistance program to better understand translation of policy to community health

ABSTRACT IMPACT: Study findings can guide improvements of the Summer Food Service Program to maximize the program’s desired effects on child summer nutrition and related health outcomes. OBJECTIVES/GOALS: The Summer Food Service Program (SFSP) addresses food insecurity during summer months. Project specific aims are to: 1. Describe characteristics of children participating in the SFSP. 2. Determine the nutritional quality of the SFSP foods. 3. Evaluate changes in children’s food insecurity, diet quality, and body mass index by SFSP participation. METHODS/STUDY POPULATION: A single group, prospective, staggered cohort design will be used for the proposed study. Two cohorts of 30 (N=60) elementary students and their parents will be recruited during the 2021-22 and 2022-23 school year. Each participant will complete a measurement session at three time-points: Baseline (spring), Post-Program (program end), and Follow-Up (following spring). Parents will complete an online survey about household food insecurity and family socio-demographic characteristics. Children will complete three 24-hour dietary recall interviews, and their heights, weight and percent body fat will be measured. The menus of at least ten SFSP sites will be analyzed to determine the nutritional adequacy of the site menus by using the Healthy Eating Index-2015. RESULTS/ANTICIPATED RESULTS: Study hypotheses are as followed: Aim 1. Not all of the children participating in the SFSP are from food-insecure or low-income households. Aim 2. Meals served at the SFSP will be higher in sugar and fat and lower in fruits and vegetables compared to recommendations in the 2015-2020 Dietary Guidelines for Americans. Additionally, the Healthy Eating Index-2015 score of the SFSP menus will be lower than that of the National School Lunch Program menus. Aim 3. Consistent SFSP participation will have a positive effect on reducing food insecurity, but not on increasing diet quality and reducing body mass index and percent body fat in children. DISCUSSION/SIGNIFICANCE OF FINDINGS: Program user information will determine if the program is reaching the target audience. Program managers will utilize menu analysis results to improve their menu nutritional quality. Changes in food insecurity, diet quality and anthropometric measures will inform whether the program needs to be improved to prevent any untoward excess weight gain.

Reducing ultra-processed foods and increasing diet quality in affordable and culturally acceptable diets: a study case from Brazil using linear programming.

The aim was to design culturally acceptable and healthy diets with reduced energetic share of ultra-processed foods (UPF%) at no cost increment and to evaluate the impact of the change in the UPF% on diet quality. Food consumption and price data were obtained from the Household Budget Survey (n 55970 households) and National Dietary Survey (n 32749 individuals). Linear programming models were performed to design diets in which the mean population UPF% was reduced up to 5 % with no cost increment relative to the observed costs. The models were isoenergetic or allowed the energy content to vary according to the UPF%, and they were not constrained to nutritional goals (nutrient-free models) or maximised the compliance with dietary recommendations (nutrient-constrained models). Constraints regarding food preference were introduced in the models to obtain culturally acceptable diets. The mean population UPF% was 23·8 %. The lowest UPF% attained was approximately 10 %. The optimised diet cost was up to 20 % cheaper than the observed cost, depending on the model and the income level. In the optimised diets, the reduction in the UPF% was followed by an increase in fruits, vegetables, beans, tubers, dairy products, nuts, fibre, K, Mg, vitamin A and vitamin C in the nutrient-constrained models, compared with the observed consumption in the population. There was little variation in most nutrients across the UPF% reduction. The UPF% reduction in the nutrient-free models impacted only trans-fat and added sugar content. UPF% reduction and increase in diet quality are possible at no cost increment.

Effects of diet quality on energy metabolism and methane production by beef steers fed a warm-season grass-based hay diet

Our objective was to determine the effects of dietary quality and protein supplementation of a low-quality warm-season hay on energy metabolism and methane emissions of beef steers.Eight cross-bred steers were used in a respiration calorimetry study with a replicated 4 × 4 Latin square design. Experimental diets were (1) a low-quality forage-based diet (7.4% CP, 66.6% NDF); (2) a low-quality forage with supplemental cottonseed meal (10.0% CP, 66.3% NDF); (3) a medium-quality forage-based diet (10.5% CP, 65.0% NDF); and 4) a high-quality forage-based diet (13.0% CP, 58.4% NDF). Diets were based on bluestem (Bothriochloa ischaemum) hay cut at 2 stages of maturity.Organic matter, fiber, energy, and protein digestibility and energy retention increased (P < 0.05) as the quality of the forage-based diets increased. Total methane production was not affected by diet, but methane production per unit of digested OM or energy retention decreased (P < 0.05) with increased diet quality. Protein supplementation of the low-quality grass hay increased (P < 0.05) DM, fiber, energy, and protein digestion but did not affect methane production. Methane production per unit of energy and protein retention decreased (P < 0.05) with protein supplementation. Enteric nitrous oxide emissions were minor and not affected by diet. An automated head chamber system gave average emission results similar to respiration chambers.Results demonstrate that protein supplementation of low-quality forage or increasing the quality of forage-based diets will potentially decrease the carbon-footprint of beef production.

Examining the Relationship Between Intuitive Eating and Diet Quality Among College Students

Abstract Objectives College students in the US tend to have low diet quality due to a confluence of interpersonal, intrapersonal, and environmental factors. Restrictive dieting is commonly used for weight management but often ineffective in the long term and can lead to dangerous eating behaviors. Intuitive eating is an adaptive form of eating that has gained interest as an alternative to restrictive dieting due to its successful use in eating disorder recovery and correlation with decreased body mass index in healthy populations. The objective of the current study was to identify if higher intuitive eating, as measured by the intuitive eating scale (IES-2), correlated with increased diet quality, as measured by the Healthy Eating Index 2015 (HEI-2015) in a college sample. Methods In this cross-sectional study, participants completed an online survey containing the IES-2 questionnaire which provides a total score for intuitive eating and four subscale scores representing the main behaviors of intuitive eating. The dietary intake of participants was assessed with up to three 24-hour diet recalls, which were completed over the phone. A total of 55 participants (40 females and 15 males) completed the survey and a minimum of two 24-hour diet recalls, which were used to calculate the HEI-2015. Independent sample t-test and Pearson's correlation were used for statistical analysis. Results The total IES-2 scores were higher for males than females (82.9 ± 8.1 vs. 76.3 ± 11.2, P = 0.04). The average total HEI-2015 score was 59.5 ± 15.1 and did not differ between gender (P = 0.93). The total IES-2 score was not significantly correlated with the total HEI scores (r = −0.218, P = 0.11), and one subscale of the IES-2, the Unconditional Permission to Eat subscale, was negatively correlated with the total HEI score (r = −0.418, P &amp;lt; 0.01) and BMI (r = −0.335, P &amp;lt; 0.05). Conclusions The results of the study do not support that intuitive eating is correlated with diet quality, furthermore, increased scores of the Unconditional Permission to Eat subscale of intuitive eating was correlated with a lower diet quality suggesting that intuitive eating and diet quality may be separate constructs that should be addressed individually. Funding Sources None.

Association of Ready-to-Eat Cereal Consumption with Nutrient and Food Group Intake and Diet Quality by Income Status Among Children, NHANES 2013–2016

Abstract Objectives Ready-to-eat (RTE) cereal is an important source of nutrients and whole grains in the diet of children and is associated with higher diet quality. Socioeconomic status is also strongly associated with nutrient intake and diet quality in the US. The objective of this study was to characterize the association between RTE cereal consumption and nutrient and food group intake and diet quality in US children ages 2 to 18 years stratified by their household income status. Methods Children age 2 to 18 years (N = 5658) in two cycles (2013–2014 and 2015–2016) of the National Health and Nutrition Examination Survey, a US nationally representative cross-sectional study, were categorized as RTE cereal eaters or non-eaters based on one day 24-hour dietary recall. Children were further stratified by their household income status according to the poverty-to-income ratio (PIR), as low-income (PIR ≤ 1.85), mid-income (PIR &amp;gt; 1.85 to &amp;lt;3.50) or high-income (PIR ≥ 3.50). Nutrient intakes, food group intake, and diet quality were compared between RTE cereal eaters and non-eaters in each income category using t-tests. Results More children in the low-income group were RTE cereal eaters (52%) compared to children in the mid-income (24%) and high-income (23%) groups. RTE cereal eaters, compared to non-eaters, in the low-income group had higher intakes of calcium (23% higher), vitamin D (85%), potassium (9%), fiber (12%), iron (71%), magnesium (11%), vitamin A (66%), and vitamin C (21%) (P &amp;lt; 0.05 for all). Conversely, only intakes of vitamin D (59% higher), iron (56%) and vitamin A (39%) were significantly higher in RTE cereal eaters than non-eaters from the high-income group (P &amp;lt; 0.05 for all). Cereal eaters also had higher intake of several key food groups including total dairy, fluid milk, and whole grains in all groups (P &amp;lt; 0.05 for all). Lastly, diet quality was significantly higher among RTE cereal eaters, compared to non-eaters, in the low- and mid-income groups (P &amp;lt; 0.05 for both) but not the high-income group. Conclusions RTE cereal is a popular, affordable food that provides under-consumed nutrients and food groups and is associated with increased diet quality particularly among low-income children. Funding Sources This study was funded by the Bell Institute of Health and Nutrition, General Mills, Inc.

A Single-Goal Fiber Intervention Does Not Compromise Nutritional Intake During Pregnancy

Abstract Objectives This study evaluated the effects of a single-goal (SG) vs. multiple goal (MG) intervention on food group and nutrient intake during pregnancy. Methods Two separate pilot studies randomized women to an intervention (SG or MG) or usual care (UC; n = 19 combined) aiming to prevent excessive gestational weight gain. Each group met weekly with a registered dietitian. In the MG study (n = 21), women were counseled on healthy eating and exercise. In the SG study (n = 16), weekly lessons focused only on increasing fiber intake (≥30 g/day); mention of all other nutrients including calories was intentionally omitted. In both studies, multiple-pass 24-hour dietary recalls were collected at baseline and end of study and analyzed with Nutrient Data System for Research (NDS-R). Diet quality was calculated using the Alternative Healthy Eating Index for Pregnancy (AHEI-P). ANOVA determined between group differences for micronutrient intake and food group servings. Paired t-tests determined within group differences in diet quality. Nutrients from dietary supplements were not included in analyses. Results All analyses reported are for data from the end of the studies. For nutrients of concern during pregnancy, when compared to the MG group, the SG group had greater calcium intake (P = 0.04). No between group difference was found for folate, iron, choline, or DHA. For food groups, when compared to the MG group, the SG group had greater fruit and whole grain intake (P &amp;lt; 0.05). No between group difference was found for protein, vegetables, nuts and legumes, or sugar-sweetened beverages (P &amp;gt; 0.05). No differences were found between SG and UC or MG and UC for any nutrients or food groups. AHEI-P score increased in the SG group during the study (P = 0.01), but not in the MG or UC groups (P &amp;gt; 0.05). Conclusions An intervention focused solely on increasing fiber intake did not cause decreased intake in other foods groups or nutrients. Only the SG group increased diet quality throughout the study. These data suggest focusing on fiber only did not create unintended negative dietary consequences and may be an effective simple message intervention for diet improvement. Larger studies are needed to further explore these results. Funding Sources This study was supported by a NIH Clinical and Translational Science Award and the Kansas City Area Life Sciences Institute.

A Community Needs Assessment of Nutrition and Behavioral Characteristics That May Impede Physical Fitness in a United States Army Reserve Unit

Abstract Objectives Perform a community needs assessment of soldiers to determine the types of programs or interventions necessary to improve physical fitness. Methods A mixed-method analysis was conducted on thirteen soldiers from a seventy-member Medical Company (Med Co.) who completed two online surveys. Of nine key informants, one provided additional information regarding the community's background conditions. The online surveys consisted of an adaptive dietary history questionnaire (DHQ3) and a complimentary Community Needs Assessment (CNA) survey that provided insight into the subjects’ community and background conditions. Results Of the total participants in this study (n = 13), the average respondent was 28 years old and male (76.9%). The average APFT score was 230, and the average total Healthy Eating Index (HEI) score was 57.8. Researchers found an inverse association between APFT and HEI scores, a positive association between HEI scores and weight loss, and a positive association between total HEI scores and time in service. Conclusions Policymakers should promote increasing diet quality by utilizing existing resources, implementing programs that provide nutrition and exercise counseling from specialized professionals, and increasing the availability of healthy foods for Reservists. Funding Sources No funding was provided to conduct this research.

Carotenoid supplementation affects the post-hibernation performance of southern corroboree frogs

Abstract Many animals hibernate to survive winter conditions, however, arousal from hibernation generates reactive oxygen species (ROS) that can cause oxidative stress. Dietary antioxidants, like carotenoids, may reduce oxidative stress during arousal from hibernation, and assist with post-hibernation recovery and performance. We tested the effect of carotenoid supplementation on exercise performance (escape-response and activity) in southern corroboree frogs (Pseudophryne corroboree) following initial arousal from hibernation (24–48 h post-arousal) and post-recovery (six weeks post-hibernation). Carotenoids did not affect performance following initial arousal. However, carotenoids improved escape-response six weeks post-hibernation, with carotenoid-supplemented frogs hopping faster and further in their first hop than unsupplemented frogs. Carotenoids also affected post-recovery activity, with carotenoid-supplemented frogs being less mobile than unsupplemented frogs. Carotenoids may affect post-hibernation performance by reducing oxidative stress or by increasing diet quality. Our study provides novel evidence for an effect of carotenoids on performance post-hibernation and highlights the importance of nutrition to hibernating organisms.

Meta-analysis of the effects of on-farm management strategies on milk yields of dairy cattle on smallholder farms in the Tropics

Although East Africa is home to one of the most advanced dairy industries in Sub-Saharan Africa, regional annual milk production is insufficient to meet the demand. The challenge of increasing milk yields (MYs) among smallholder dairy cattle farmers (SDCFs) has received considerable attention and resulted in the introduction of various dairy management strategies (DMSs). Despite adoption of these DMSs, MYs remain low on-farm and there is a large discrepancy in the efficacy of DMSs across different farms. Therefore, the present study sought to: (1) identify on-farm DMSs employed by East African SDCFs to increase MYs and (2) summarize existing literature to quantify the expected MY changes associated with these identified DMSs. Data were collected through a comprehensive literature review and in-depth semi-structured interviews with 10 experts from the East African dairy sector. Meta-analysis of the literature review data was performed by deriving four multivariate regression models (i.e. models 1 to 4) that related DMSs to expected MYs. Each model differed in the weighting strategy used (e.g. number of observations and inverse of the standard errors) and the preferred model was selected based on the root estimated error variance and concordance correlation coefficient. Nine DMSs were identified, of which only adoption of improved cattle breeds and improved feeding (i.e. increasing diet quality and quantity) consistently and significantly (P < 0.05) increased daily MYs across the available studies. Improved breeds alongside adequate feeding explained ≤50% of the daily MYs observed in the metadata while improved feeding explained ≤30% of the daily MYs observed across the different models. Conversely, calf suckling significantly (P < 0.05) reduced MYs according to model 2. Other variables including days in milk, trial length and maximum ambient temperature (used as a proxy for heat stress) contributed significantly to decreasing MYs. These variables may explain some of the heterogeneity in MY responses to DMSs reported in the literature. Our results suggest that using improved cattle breeds alongside improved feeding is the most reliable strategy to increase MYs on-farm in East Africa. Nevertheless, these DMSs should not be considered as standalone solutions but as a pool of options that should be combined depending on the resources available to the farmer to achieve a balance between using dairy cattle genetics, proper husbandry and feeding to secure higher MYs.

Tip 1 Diyabetli Çocuk ve Adölesanların Diyet Kalitesi, Diyet Asit Yükü ve Glisemik Kontrol ile İlişkisi

Amaç: Artmış diyet kalitesi, Tip 1 Diabetes Mellitus’ta (T1DM) iyi bir metabolik kontrol ve azalmış komplikasyon riski ile ilişkili olabilirken, günümüzde sıkça tüketilen Batı tarzı diyetlerin düşük diyet kalitesi ve yüksek diyet asit yüküne sahip olduğu gösterilmiştir. Bu araştırmada, T1DM’li çocuk ve adölesanların diyet kalitesi ve asit yükünün saptanması ve bu parametrelerin metabolik kontrol ile ilişkisinin değerlendirilmesi amaçlanmıştır.&#x0D; Bireyler ve Yöntem: Araştırmaya, 8-18 yaş arasında 75 T1DM’li ve 88 sağlıklı birey dahil edilmiş ve tüm katılımcıların antropometrik ölçümleri yapılmıştır. Diyet kalitesinin ve asit yükünün saptanabilmesi için 24 saatlik geriye dönük besin tüketim kaydı alınmıştır. Diyet kalitesi, Sağlıklı Yeme İndeksi (SYİ)-2015 ve Türkiye Beslenme Rehberi’ne (TÜBER) göre revize edilen SYİ-2015 ile değerlendirilmiştir. Diyet asit yükünün tahmini ise potansiyel renal asit yükü (PRAL) değeri ve net endojen asit üretimi (NEAP) skoru hesaplanarak yapılmıştır. Metabolik kontrolün göstergesi olarak, son ölçülen HbA1c değerleri kaydedilmiştir.&#x0D; Bulgular: Araştırma sonucunda, T1DM’li grubun diyet kalitesi (SYİ-2015: 50.5±10.2, TÜBER’e göre SYİ-2015: 45.5±9.6) sağlıklı gruptan (SYİ-2015: 43.9±10.7, TÜBER’e göre SYİ-2015: 37.8±10.9) daha yüksek ve diyet asit yükleri daha düşük (diyabetlilerde PRAL: -3.5±20.4, NEAP: 39.3±16.4; sağlıklı PRAL: 9.8±15.0, NEAP: 55.9±21.6 mEq/gün) bulunmuştur (p&lt;0.001). Ayrıca, diyabetik grupta PRAL ve NEAP skorları ile HbA1c düzeyleri arasında pozitif yönde bir ilişki saptanırken, TÜBER’e göre SYİ-2015 toplam puanları ile HbA1c arasında negatif yönde bir ilişki olduğu görülmüştür (p&lt;0.05).&#x0D; Sonuç: T1DM’li çocukların ve ergenlerin diyet kalitesi sağlıklı yaşıtlarından daha iyi olsa da, T1DM’li kişilerin diyet kalitesi önerilen sınıflandırmaya göre hala orta-düşük düzeydeydi. Ayrıca, diyet kalitesinin iyileştirilmesi ve diyet asit yükünün azaltılması, iyi bir metabolik kontrol için faydalı olabilir.

The Effect of a Digital Behavioral Weight Loss Intervention on Adherence to the Dietary Approaches to Stop Hypertension (DASH) Dietary Pattern in Medically Vulnerable Primary Care Patients: Results from a Randomized Controlled Trial

BackgroundObesity treatment focuses primarily on reducing overall caloric intake with limited focus on improving diet quality. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is effective in managing hypertension and other chronic conditions, yet it is not clear whether behavioral weight control interventions improve DASH adherence. We conducted a post hoc analysis of a behavioral weight loss intervention that did not emphasize diet quality and examined whether the intervention impacted DASH adherence in medically vulnerable community health center patients. MethodsParticipants (n=306) were enrolled in Track, a randomized controlled weight loss intervention for patients with elevated cardiovascular risk. The trial compared usual care to an intervention with weekly self-monitoring, tailored feedback on diet and exercise goals, and dietitian and provider counseling in community health centers. Dietary intake was measured using the Block Food Frequency Questionnaires collected at baseline and 12 months. DASH adherence was determined using previously validated scoring indices that assessed adherence based on recommended nutrient or food group targets. Total scores for both indices ranged from 0 to 9, with higher scores indicating greater DASH adherence. ResultsThe mean (and standard deviation [SD]) age of participants was 51.1 (SD=8.8) years and the mean body mass index was 35.9 (SD=3.9). Most were female (69%) and black (51%); 13% were Hispanic. Half (51%) had an annual income <$25,000 and 33% had both diabetes and hypertension. At baseline, the mean DASH nutrient score was 1.81 (SD=1.42) with 6% achieving at least a score of 4.5. Similar scores were seen for the DASH foods index. The intervention group saw significantly greater, albeit small, improvements in mean DASH nutrient score (intervention: 1.28 [SD=1.5] vs control: 0.20 [SD=1.3]; P<0.001), and there was no difference in DASH food score between study arms. There were no significant predictors of change in DASH score and no association between DASH adherence and changes in blood pressure. Within the intervention arm, improvements in DASH nutrient score were associated with greater weight loss (r=−0.28; P=0.003). ConclusionAlthough the intervention was not designed to increase adoption of DASH, the Track intervention produced significant weight loss and small improvements in DASH adherence. Despite these small improvements, overall adoption of DASH was poor among the medically vulnerable patients enrolled in Track. To further reduce chronic disease burden, weight loss interventions should include a focus on both caloric restriction and increasing diet quality.