Nutrition Literature Research Articles

Store Formats, Market Structure, and Consumers’ Food Shopping Decisions

AbstractA growing literature in health and nutrition suggests that healthy foods are less available and more expensive at nontraditional store formats such as supercenters, convenience stores, and drug stores. We use Nielsen Homescan data to investigate the relationship between store format and the healthfulness of consumers’ grocery shopping. Accounting for a rich set of controls, as well as food retail market structure, we simultaneously estimate the healthfulness of consumers’ food purchases and the shares of food expenditure at traditional and nontraditional store formations. We find that healthier food choices are generally associated with higher food expenditure shares at supermarkets and supercenters and lower shares at drug stores and convenience stores. In addition, market concentration has a negative effect on shopping healthfulness.

Evidence-Based Support for Nutrition Therapy in Head and Neck Cancer.

Purpose of ReviewPatients diagnosed with head and neck (H&N) cancer often present in a malnourished state for varied reasons; nutritional optimization is therefore critical to the success of treatment for these complex patients. This article aims to review the current nutrition literature pertaining to H&N cancer patients and to present evidence-based strategies for nutritional support specific to this population.Recent FindingsAggressive nutritional intervention is frequently required in the H&N cancer patient population. Rehabilitating nutrition during operative and nonoperative treatment improves compliance with treatment, quality of life, and clinical outcomes. When and whether to establishing alternative enteral access are points of controversy, although recent evidence suggests prophylactic enteral feeding tube placement should not be universally applied. Perioperative nutritional optimization including preoperative carbohydrate loading and provision of arginine-supplemented immunonutrition has been shown to benefit at-risk H&N cancer patients.SummaryWith multidisciplinary collaboration, H&N cancer patients can receive individualized nutritional support to withstand difficult cancer treatment regimens and return to acceptable states of nutritional health.

Application of Artificial Neural Network and Support Vector Machines in Predicting Metabolizable Energy in Compound Feeds for Pigs.

In the nutrition literature, there are several reports on the use of artificial neural network (ANN) and multiple linear regression (MLR) approaches for predicting feed composition and nutritive value, while the use of support vector machines (SVM) method as a new alternative approach to MLR and ANN models is still not fully investigated. The MLR, ANN, and SVM models were developed to predict metabolizable energy (ME) content of compound feeds for pigs based on the German energy evaluation system from analyzed contents of crude protein (CP), ether extract (EE), crude fiber (CF), and starch. A total of 290 datasets from standardized digestibility studies with compound feeds was provided from several institutions and published papers, and ME was calculated thereon. Accuracy and precision of developed models were evaluated, given their produced prediction values. The results revealed that the developed ANN [R2 = 0.95; root mean square error (RMSE) = 0.19 MJ/kg of dry matter] and SVM (R2 = 0.95; RMSE = 0.21 MJ/kg of dry matter) models produced better prediction values in estimating ME in compound feed than those produced by conventional MLR (R2 = 0.89; RMSE = 0.27 MJ/kg of dry matter). The developed ANN and SVM models produced better prediction values in estimating ME in compound feed than those produced by conventional MLR; however, there were not obvious differences between performance of ANN and SVM models. Thus, SVM model may also be considered as a promising tool for modeling the relationship between chemical composition and ME of compound feeds for pigs. To provide the readers and nutritionist with the easy and rapid tool, an Excel® calculator, namely, SVM_ME_pig, was created to predict the metabolizable energy values in compound feeds for pigs using developed support vector machine model.

A comprehensive approach to understanding cooking behavior

PurposeThe purpose of this paper is to describe the development of – and need for – an expanded understanding of cooking (skills and knowledge) to inform research on the connection between cooking and health.Design/methodology/approachThis paper describes a concept of “food agency” and contrasts it with how cooking is commonly conceived in food and nutrition literature. A food agency-based pedagogy and proposals for using it are also introduced.FindingsCooking is a complex process that may be crucial for making a difference in the contemporary problems of diet-related chronic diseases. There are two interlinked problems with present research on cooking. First, cooking has yet to be adequately conceptualized for the design and evaluation of effective public health and nutrition interventions. The context within which food-related decisions and actions occur has been neglected. Instead, the major focus has been on discrete mechanical tasks. In particular, recipes are relied upon despite no clear evidence that recipes move people from knowledge to action. Second, given the incomplete theorization and definition of this vital everyday practice, intervention designs tend to rely on assumptions over theory. This creates certain forms of tautological reasoning when claims are made about how behavior changes. A comprehensive theory of food agency provides a nuanced understanding of daily food practices and clarifies how to teach cooking skills that are generalizable throughout varied life contexts.Originality/valueThis commentary is of value to academics studying cooking-related behavior and public health practitioners implementing and evaluating cooking interventions.

Estimation of the maximum safe level of feed ingredients by spline or broken-line nonlinear regression models

The use of non-linear regression models in the analysis of biological data has led to advances in poultry nutrition. Spline or broken-line nonlinear regression models are commonly used to estimate nutritional requirements. One particular application of broken-line models is estimating the maximum safe level (MSL) of feed ingredients beyond which the ingredients become toxic, resulting in reduced performance. The objectives of this study were to evaluate the effectiveness of broken-line models (broken-line linear or BLL; and broken-line quadratic or BLQ) in estimating the MSL; to identify the most efficient design of feeding trials by finding the optimal number of ingredient levels and replications; and to re-estimate the MSL of various test ingredients reported in the nutrition literature for comparison purposes. The Maximum Ingredient level Optimization Workbook (MIOW) was developed to simulate a series of experiments and estimate the MSL and the corresponding descriptive statistics (SD, SE, CI, and R2). The results showed that the broken-line models provided good estimates of the MSL (small SE and high R2) with the BLL model producing higher MSL values as compared to the BLQ model. Increasing the number of experimental replications or ingredient levels (independently of each other) reduced the SE of the MSL with diminishing returns. The SE of the MSL was reduced with increasing the size (total pens) of the simulated experiments by increasing either the number of replications or levels or both. The evaluation of MSLs reported in the existing literature revealed that the multiple range procedure used to determine the MSL in several reports can both overestimate and underestimate the MSL compared to the results obtained by the broken-line models. The results suggest that the broken-line linear models can be used in lieu of the multiple range test to estimate the MSL of feed ingredients along with the corresponding descriptive statistics, such as the SE of the MSL.

Costing Methods for a Cluster‐Randomized Cost‐Effectiveness Trial Comparing the Performance of Four Supplementary Foods in Treating Sierra Leonean Children with Moderate Acute Malnutrition (MAM)

It is widely recognized that cost‐effectiveness (CE) estimates generated by economic evaluations should enter into decision‐making for health and nutrition policy and programming. However, many existing evaluations of nutrition interventions focus on effectiveness, assessing comparative nutrition and health outcomes without considering their associated costs. Moreover, despite recognizing the importance of measuring costs in generating CE estimates, many researchers find costing to be a challenging task with limited guidance and few examples of cost data collection methods in the international nutrition literature. This communication aims to help guide researchers on costing methods for research for cost‐effective policy‐making and programming.As part of the Food Aid Quality Review Phase III (FAQR III) Project, a USAID/FFP‐funded project implemented by Tufts University, a comprehensive costing protocol was designed for a cluster‐randomized field trial in Sierra Leone evaluating the comparative cost‐effectiveness of treating children under‐5 with MAM with one of four iso‐caloric supplementary foods: Super Cereal Plus with amylase, Corn‐Soy Blend Plus given with fortified vegetable oil (FVO), an innovative formulation called Corn‐Soy‐Whey Blend given with FVO, and Ready‐to‐Use‐Supplementary Food. The primary effectiveness outcome is recovery from MAM defined as reaching MUAC ≥ 12.5 cm within the 12‐week treatment period.To determine CE, we will assess costs using three “lenses”. The Program Costs lens includes non‐research costs incurred as part of this trial, including fixed, start‐up and ongoing costs of food products, transportation, storage, programming, beneficiaries, personnel, equipment, materials and facilities. Monetary costs and opportunity costs incurred within these components will be estimated using data collected from key informant interviews, direct observation, time tracking forms as well as accounting documents and inventory records. The Adjusted Program Costs lens will be the estimated costs for an NGO seeking to replicate this program in a similar setting. Interviews with local NGO partners and market surveys will be conducted to estimate the costs that an NGO would face. The third lens will conduct Policy Experiments to estimate costs that may be incurred when moving from the current limited setting to larger‐scale and longer interventions.Within each lens, we will calculate summary cost estimates per study arm including total program cost, cost per child treated, and cost per child‐month treated. We will link these cost estimates to the primary effectiveness measure, recovery from MAM, to derive the CE estimate of cost per recovered child and compare CE among the four study arms. Both absolute CE measures (e.g. cost per child recovered for each arm) and relative CE measures (e.g. incremental cost‐effectiveness ratio comparing each arm to a reference arm) will be calculated.Support or Funding InformationThis research is made possible by the generous support of the American people through the U.S. Agency for International Development (USAID) Office of Food for Peace of the Bureau for Democracy, Conflict and Humanitarian Assistance, and the World Food Programme under the terms of the Contract AID‐OAA‐C‐16‐00020, managed by Tufts University. The contents are the responsibility of Tufts University and its partners in the Food Aid Quality Review (FAQR) and do not necessarily reflect the views of USAID, the United States Government, or the World Food Programme.

Agriculture, Food Systems, and Nutrition: Meeting the Challenge.

Malnutrition is a global challenge with huge social and economic costs; nearly every country faces a public health challenge, whether from undernutrition, overweight/obesity, and/or micronutrient deficiencies. Malnutrition is a multisectoral, multi‐level problem that results from the complex interplay between household and individual decision‐making, agri‐food, health, and environmental systems that determine access to services and resources, and related policy processes. This paper reviews the theory and recent qualitative evidence (particularly from 2010 to 2016) in the public health and nutrition literature, on the role that agriculture plays in improving nutrition, how food systems are changing rapidly due to globalization, trade liberalization, and urbanization, and the implications this has for nutrition globally. The paper ends by summarizing recommendations that emerge from this research related to (i) knowledge, evidence, and communications, (ii) politics, governance, and policy, and (iii) capacity, leadership, and financing.

Parenteral or Enteral Arginine Supplementation Safety and Efficacy

Arginine supplementation has the potential to improve the health of patients. Its use in hospitalized patients has been a controversial topic in the nutrition literature, especially concerning supplementation of septic patients. In this article, we review the relevant literature both for and against the use of arginine in critically ill, surgical, and hospitalized patients. The effect of critical illness on arginine metabolism is reviewed, as is its use in septic and critically ill patients. Although mounting evidence supports immunonutrition, there are only a few studies that suggest that this is safe in patients with severe sepsis. The use of arginine has been shown to benefit a variety of critically ill patients. It should be considered for inclusion in combinations of immunonutrients or commercial formulations for groups in whom its benefit has been reported consistently, such as those who have suffered trauma and those in acute surgical settings. The aims of this review are to discuss the role of arginine in health, the controversy surrounding arginine supplementation of septic patients, and the use of arginine in critically ill patients.

Political economy challenges in nutrition.

BackgroundHistorically, implementing nutrition policy has confronted persistent obstacles, with many of these obstacles arising from political economy sources. While there has been increased global policy attention to improving nutrition in recent years, the difficulty of translating this policy momentum into results remains.DiscussionWe present key political economy themes emanating from the political economy of nutrition literature. Together, these interrelated themes create a complex web of obstacles to moving nutrition policy forward. From these themes, we frame six political economy challenges facing the implementation of nutrition policy today. Building awareness of the broader political and economic issues that shape nutrition actions and adopting a more systematic approach to political economy analysis may help to mitigate these challenges.ConclusionImproving nutrition will require managing the political economy challenges that persist in the nutrition field at global, national and subnational levels. We argue that a “mindshift” is required to build greater awareness of the broader political economy factors shaping the global nutrition landscape; and to embed systematic political economy analysis into the work of stakeholders navigating this field. This mindshift may help to improve the political feasibility of efforts to reform nutrition policy and implementation—and ensure that historical legacies do not continue to shape the future.

Best (but oft-forgotten) practices: intention-to-treat, treatment adherence, and missing participant outcome data in the nutrition literature

Among clinical trials of adequate size, randomization balances both known and unknown prognostic factors between trial arms, thus allowing an unbiased comparison of intervention and control. To preserve this benefit, all randomly assigned participants should be followed to study termination and analyzed in the arm to which they were allocated. There are 2 potential limitations in study implementation: 1) patients are nonadherent and continue with follow-up visits, or 2) patients are lost to follow-up and their outcome data are missing. Herein, we address these issues with an emphasis on binary outcomes, and discuss how authors of randomized trials should address issues of both noncompliance and missing data.

Invited review: Experimental design, data reporting, and sharing in support of animal systems modeling research.

The National Animal Nutrition Program "National Research Support Project 9" supports efforts in livestock nutrition, including the National Research Council's committees on the nutrient requirements of animals. Our objective was to review the status of experimentation and data reporting in animal nutrition literature and to provide suggestions for the advancement of animal nutrition research and the ongoing improvement of field-applied nutrient requirement models. Improved data reporting consistency and completeness represent a substantial opportunity to improve nutrition-related mathematical models. We reviewed a body of nutrition research; recorded common phrases used to describe diets, animals, housing, and environmental conditions; and proposed equivalent numerical data that could be reported. With the increasing availability of online supplementary material sections in journals, we developed a comprehensive checklist of data that should be included in publications. To continue to improve our research effectiveness, studies utilizing multiple research methodologies to address complex systems and measure multiple variables will be necessary. From the current body of animal nutrition literature, we identified a series of opportunities to integrate research focuses (nutrition, reproduction and genetics) to advance the development of nutrient requirement models. From our survey of current experimentation and data reporting in animal nutrition, we identified 4 key opportunities to advance animal nutrition knowledge: (1) coordinated experiments should be designed to employ multiple research methodologies; (2) systems-oriented research approaches should be encouraged and supported; (3) publication guidelines should be updated to encourage and support sharing of more complete data sets; and (4) new experiments should be more rapidly integrated into our knowledge bases, research programs and practical applications.

The traditional food of migrants: Meat, water, and other challenges for dietary advice. An ethnography in Guanajuato, Mexico

The term “traditional diet” is used variously in public health and nutrition literature to refer to a substantial variety of foodways. Yet it is difficult to draw generalities about dietary tradition for specific ethnic groups. Given the strong association between migration and dietary change, it is particularly important that dietary advice for migrants be both accurate and specific. In this article, I examine the cultural construct of “traditional foods” through mixed method research on diet and foodways among rural farmers in Guanajuato, MX and migrants from this community to other Mexican and U.S. destinations. Findings reveal first, that quantitatively salient terms may contain important variation, and second, that some “traditional” dietary items –like “refresco,” “carne,” and “agua” – may be used in nutritionally contradictory ways between clinicians and Mexican immigrant patients. Specifically, the term “traditional food” in nutritional advice for Mexican migrants may be intended to promote consumption of fresh produce or less meat; but it may also invoke other foods (e.g., meats or corn), inspire more regular consumption of formerly rare foods (e.g., meats, flavored waters), or set up financially impossible goals (e.g., leaner meats than can be afforded). Salience studies with ethnographic follow up in target populations can promote the most useful and accurate terms for dietary advice.

Early Enteral Nutrition in Trauma: Is There Still Any Doubt?

Early enteral nutrition support has been standard in the care of the injured patient for nearly three decades. The Eastern Association for the Surgery of Trauma (EAST) provided the most recent management recommendations for nutritional support of trauma patients in 2004. Simply stated, the recommendation provided by the authors described the superiority of support via the enteral route within the first 72 h of injury when feasible. This statement implied that both the timing of initiation and route of support had potential to impact patient outcomes. The American Society of Parenteral and Enteral Nutrition (ASPEN) in conjunction with the Society of Critical Care Medicine (SCCM) published a broader set of guidelines in 2009 and 2016 that generally agreed with the EAST recommendations and were applicable to critically ill patients. The superiority of the enteral route for delivery of nutritional support has been theorized to be associated with the non-nutritional benefits of substrate provision at the level of the gastrointestinal tract within a 72-h therapeutic window. These concepts, at least in part, were the product of trials performed by surgeons in the setting of severe trauma and are now applied broadly to critically ill patients. However, as is clearly stated in the above guidelines, there are significant limitations inherent in the available literature. The breadth of literature in clinical nutrition has been plagued with issues including small trial size, the presence of multiple confounding variables, diverse control groups, and heterogeneous patient populations. Trials examining the role of early enteral nutrition support in injured patients have similar limitations. Over the last decade several significant trials have been conducted examining questions regarding nutrition support in the ICU, many of which conflict with historical findings. As a result of these trials, the practice of clinical nutrition is evolving rapidly. The objectives of this review include the following: discussion of the historical perspective on nutrition support in the setting of trauma, brief summary of existing data and more recent trials of importance, and how these trials may impact longstanding dogma.

Combating the Health Risks of Sedentary Behavior in the Contemporary Radiology Reading Room.

We detail the association of sedentary behavior with a variety of health problems and provide the radiologist with a number of simple activities and techniques that can improve overall health while still meeting the productivity demands of a high-volume practice. Although these techniques are well known and recognized in the fitness and nutrition literature, they are not widely used in the radiology reading room. The computer- and workstation-based work routinely performed by diagnostic radiologists typically occurs in the seated position, leading to more than 8 hours per day of sitting. Studies have found that even for those who exercise regularly, spending increased time sitting can negate the healthful effects of exercise. Time spent in a seated or sedentary position leads to slowing of one's metabolism, with negative resultant effects. The concept of nonexercise activity thermogenesis (NEAT) will be described, with examples given of how to burn more calories while at work and, therefore, improve the health of the diagnostic radiologist. NEAT refers to the energy expended during activities of daily living, excluding sportlike or intentional exercise. The concept of NEAT must be understood by radiologists, because it allows the development of multiple strategies to combat the ill effects of sitting while working. Adding intermittent movement and stretching exercises throughout the day can stimulate metabolism. An understanding of the association of sedentary work behavior with a number of health risks is crucial for radiologists so that they can implement basic changes into their work routine, allowing them to increase activity to address and avoid these potential health hazards.

Best (but oft-forgotten) practices: sensitivity analyses in randomized controlled trials

A randomized controlled clinical trial is the best way to minimize bias in ascertaining treatment effects, but the credibility of the results of a trial depends on the validity of the methods used to analyze the data, and the conditions under which such methods produce valid answers. A sensitivity analysis is a method to determine the robustness of trial findings by examining the extent to which results are affected by changes in methods, models, values of unmeasured variables, or assumptions. The goal of a sensitivity analysis is to identify results that are most dependent on questionable or unsupported assumptions. In this article, we briefly review the current use of sensitivity analyses in a random sample of published nutrition literature and provide a guide on the use of sensitivity analyses in randomized trials as to when to consider them, what to consider when planning them, and different methods of implementing them. We propose an 8-step strategy for improving the approach to conducting and reporting sensitivity analyses in nutrition-based trials.

ATNT-24KETOGENIC DIETS IN CANCER THERAPIES: ARE WE SPEAKING THE SAME LANGUAGE?

BACKGROUND: The definition and parameters of the ketogenic diet are not universal. Consistency of terms, type of diet and measurement of ketones need to be defined. These therapies and the parameters have been well established in the nutrition and neurology literature, but require standardization if ketosis is going to be evaluated as an oncologic therapy. METHODS: Comparison of ketogenic diets to other modified diets that are commonly thought of as ketogenic diets includes the following: Classic Ketogenic Diet (KD), Medium Chain Triglyceride oil diet (MCT), Low Glycemic Index Therapy (LGIT), Modified Atkins (MAD and Atkins (AD) diets and the biological parameters for monitoring ketosis (labs, including blood and or urine ketones). RESULTS: Comparison graphics for the KD, MCT, LGIT, MAD and AD will be presented and will include the following: Proportions of fat, protein and carbohydrate in each type of diet; how foods are measured, whether calories are controlled; presence of blood and urine ketones reported for each diet; and one sample day of each diet. CONCLUSIONS: Ketogenic diet therapies (KD, MCT, LGIT, MAD, and AD) are complicated and different from the public's thinking of a healthy diet for cancer. Individual patient's response and compliance with different diets vary. Without consensus about what constitutes a ketogenic diet and twice daily measurements of blood ketones to ensure the state of ketosis is maintained, metabolic changes cannot be documented. Since the purpose of this therapy is to induce the state of ketosis, the type of ketogenic diet used must actually promote ketone formation and be monitored. Without those key elements, comparisons between trials cannot be achieved and the value of the ketogenic diet as an anticancer treatment will remain an unanswered question.

Preventing bioenergetic failure in the preterm infant

The failure to match postnatal nutritional requirements to support growth and well-being in the extremely preterm infant has been a long-standing challenge with slow progress. Several large prospective cohorts over...

MIND diet slows cognitive decline with aging

IntroductionThe Mediterranean and dash diets have been shown to slow cognitive decline; however, neither diet is specific to the nutrition literature on dementia prevention. MethodsWe devised the Mediterranean-Dietary Approach to Systolic Hypertension (DASH) diet intervention for neurodegenerative delay (MIND) diet score that specifically captures dietary components shown to be neuroprotective and related it to change in cognition over an average 4.7 years among 960 participants of the Memory and Aging Project. ResultsIn adjusted mixed models, the MIND score was positively associated with slower decline in global cognitive score (β = 0.0092; P < .0001) and with each of five cognitive domains. The difference in decline rates for being in the top tertile of MIND diet scores versus the lowest was equivalent to being 7.5 years younger in age. DiscussionThe study findings suggest that the MIND diet substantially slows cognitive decline with age. Replication of these findings in a dietary intervention trial would be required to verify its relevance to brain health.

Nutrition and metabolic support for critically ill patients.

Acute critical illness increases the risk of malnutrition, are more obese, and have multiple comorbidities and frequent pre-existing nutritional deficits. There is a vast amount of research and literature being written on nutritional practices in the critically ill. We review and discuss herein the important nutrition literature over the past 12 months. Sarcopenia, defined as loss of skeletal mass and strength, is associated with increased mortality and morbidity, particularly in elderly patients with trauma. Ultrasound is emerging as a noninvasive and promising method of measuring muscularity. Measuring gastric residuals and postpyloric feeding may not decrease rates of pneumonia in critically ill patients. Trophic and full feeding lead to similar long-term functional and cognitive outcomes in patients with acute respiratory distress syndrome. Nutrition and metabolic support of critically ill patients is a complex and diverse topic. Nutritional measurements, requirements, and modes and routes of delivery are currently being studied to determine the best way to treat these complicated patients. We present just a few of the current controversial topics in this fascinating arena.

The Pivotal Role of Aldehyde Toxicity in Autism Spectrum Disorder: The Therapeutic Potential of Micronutrient Supplementation.

Autism spectrum disorder (ASD) is characterized by social and communication impairments as well as by restricted, repetitive patterns of behavior and interests. Genomic studies have not revealed dominant genetic errors common to all forms of ASD. So ASD is assumed to be a complex disorder due to mutations in hundreds of common variants. Other theories argue that spontaneous DNA mutations and/or environmental factors contribute to as much as 50% of ASD. In reviewing potential genetic linkages between autism and alcoholism, it became apparent that all theories of ASD are consistent with aldehyde toxicity, in which endogenous and exogenous aldehydes accumulate as a consequence of mutations in key enzymes. Aldehyde toxicity is characterized by cell-localized, micronutrient deficiencies in sulfur-containing antioxidants, thiamine (B1), pyridoxine (B6), folate, Zn2+, possibly Mg2+, and retinoic acid, causing oxidative stress and a cascade of metabolic disturbances. Aldehydes also react with selective cytosolic and membrane proteins in the cell of origin; then some types migrate to damage neighboring cells. Reactive aldehydes also form adducts with DNA, selectively mutating bases and inducing strand breakage. This article reviews the relevant genomic, biochemical, and nutritional literature, which supports the central hypothesis that most ASD symptoms are consistent with symptoms of aldehyde toxicity. The hypothesis represents a paradigm shift in thinking and has profound implications for clinical detection, treatment, and even prevention of ASD. Insight is offered as to which neurologically afflicted children might successfully be treated with micronutrients and which children are unlikely to be helped. The aldehyde toxicity hypothesis likely applies to other neurological disorders.