Non-starchy Vegetables Research Articles

Comparative analysis between a brief nutrition screening survey and validated food frequency questionnaire among physically active college students

Objective To evaluate the agreement between a 61-item Nutrition Screening Survey (NSS) and 127-item validated Food Frequency Questionnaire (FFQ). Participants Forty-seven college students (male, n = 29; female, n = 18), age 21.7 ± 0.4 years, BMI of 23.5 ± 0.4 kg/m2. Methods Participants completed the NSS, Block FFQ, and anthropometric measurements. Pearson’s correlation, paired sample t test, and Bland–Altman plot evaluated agreement between the assessments. Results Moderate to strong associations between assessments (0.61–0.89, p < 0.001) were identified for meals/day, snacks/day, calories, carbohydrate, fiber, grains, non-starchy vegetables, potatoes, legumes, fruit, yogurt, cheese, and eggs. Mean daily meals/day, calories, fat, fiber, grains, fruit, milk, and eggs did not significantly differ between surveys. The Bland–Altman plot analyses indicated no proportional bias for calories, fat, fiber, grains, fruit, milk, and eggs. Conclusions The NSS and Block FFQ display reasonable agreement, supporting use of the NSS for evaluating a range of dietary components among physically active college students.

Associations Among Select State Policies and the Nutritional Quality of Household Packaged Food Purchases in the United States from 2008 Through 2017

BackgroundPolicy interventions are important public health tools because they can reach large numbers of people. State context has been associated with health outcomes, yet few studies have examined the extent to which state-level policies are associated with dietary quality. ObjectivesThe objective of this study was to evaluate whether state policies are associated with the nutritional quality of household packaged food purchases. DesignThis observational study used data from Nielsen Homescan, an open-cohort household panel where participants track purchases, and a combination of state-level food and social safety net policy variables from 2008 through 2017. Participants and settingThis study included 615,634 household-year observations in the United States from 2008 through 2017. Household-year observations were excluded in the case that a household did not make a minimum number of purchases and in the case that they had incorrect geographic information. The final analytic sample was 611,719 household-years. Main outcome measuresStudy outcomes included a set of nutrition-related measures of public health interest, including nutrients of concern (eg, sugar, saturated fat, and sodium) and calories from specific food groups (eg, fruits, nonstarchy vegetables, processed meats, mixed dishes, sugar-sweetened beverages, and desserts and snacks). Statistical analysisThis study used multilevel generalized linear models with state fixed effects on three samples: all households, only households with low income, and only households with low educational attainment. ResultsFew significant associations were found between healthy food retail policies and the nutritional quality of purchases, and mixed associations were found between social safety net policies and lower or higher quality packaged food purchases. ConclusionsLittle evidence was found that state policy context in 2008 through 2017 was associated with the quality of packaged food purchases. However, variation in state policies is increasing over time, warranting future research into the relationship between these policies, the quality of packaged food purchases, and the rest of the diet.

P61 Relationship Between Adults’ Dietary Habits and Food Security Status Amid COVID-19

BackgroundCOVID-19 rapidly spread throughout the United States (US) early in 2020. In March, the US federal government mandated that all residents and citizens remain in quarantine to reduce the spread and ease the burden on the healthcare system, which unwillingly impacted the rise in unemployment. Even though these preventative measures were necessary, it may have unwillingly shifted dietary habits based on food security status.ObjectiveTo identify adults’ demographics, dietary habits, and its relationship with food security status amid COVID-19.Study Design, Setting, ParticipantsAn online cross-sectional study was conducted between April – June 2020 throughout the United States. Participants (n = 3,133) completed a demographic questionnaire, the modified Dana-Farber's Cancer Institute Eating Habits Questionnaire and USDA Food Security Module once during the study period.Measurable Outcome/AnalysisFrequency counts and percentages were tabulated for demographics, dietary habits, and food security scores. One-way ANOVAs were conducted to evaluate relationships between dietary habits and food security status and correlations among demographics using STATA v14 at a statistical significance level of P < 0.05.ResultsParticipants were White (84.5%), female (79.4%), and between the ages of 30 to 49 years old (30.2%). Participants increased their consumption of sweets (43.8%) and salty snacks (37.4%) and decreased their consumption of fruit (33.4%), poultry products (31%) and non-starchy vegetables (28.2%). Average scores for food security were 0.69 ± 1.77. Per each month, there was a relationship between dietary habits and food security status; April (P < 0.02), May (P < 0.000) and June (P < 0.03). A significant negative correlation was found for female sex (P = 0.009), race (P < 0.001), and age range (P < 0.001) with total dietary habits score.ConclusionCOVID-19 continues to affect individuals, which influences the relationship between dietary habits and food security status. Future population studies are recommended in the US to help public health authorities frame actions to alleviate the impact of COVID-19 has on dietary habits and food security to minimize the risk factors today and in future inevitable pandemics. COVID-19 rapidly spread throughout the United States (US) early in 2020. In March, the US federal government mandated that all residents and citizens remain in quarantine to reduce the spread and ease the burden on the healthcare system, which unwillingly impacted the rise in unemployment. Even though these preventative measures were necessary, it may have unwillingly shifted dietary habits based on food security status. To identify adults’ demographics, dietary habits, and its relationship with food security status amid COVID-19. An online cross-sectional study was conducted between April – June 2020 throughout the United States. Participants (n = 3,133) completed a demographic questionnaire, the modified Dana-Farber's Cancer Institute Eating Habits Questionnaire and USDA Food Security Module once during the study period. Frequency counts and percentages were tabulated for demographics, dietary habits, and food security scores. One-way ANOVAs were conducted to evaluate relationships between dietary habits and food security status and correlations among demographics using STATA v14 at a statistical significance level of P < 0.05. Participants were White (84.5%), female (79.4%), and between the ages of 30 to 49 years old (30.2%). Participants increased their consumption of sweets (43.8%) and salty snacks (37.4%) and decreased their consumption of fruit (33.4%), poultry products (31%) and non-starchy vegetables (28.2%). Average scores for food security were 0.69 ± 1.77. Per each month, there was a relationship between dietary habits and food security status; April (P < 0.02), May (P < 0.000) and June (P < 0.03). A significant negative correlation was found for female sex (P = 0.009), race (P < 0.001), and age range (P < 0.001) with total dietary habits score. COVID-19 continues to affect individuals, which influences the relationship between dietary habits and food security status. Future population studies are recommended in the US to help public health authorities frame actions to alleviate the impact of COVID-19 has on dietary habits and food security to minimize the risk factors today and in future inevitable pandemics.

Effects of a Low Carbohydrate Diet on Patients With Metabolic Syndrome Complicated by Non-alcoholic Fatty Liver Disease (NAFLD)

ObjectivesTo assess the impact of low carbohydrate (LC) diet on weight, metabolic and liver-related parameters among patients with metabolic syndrome (MS) and NAFLD. Methods79 white patients (median 44 years) with MS who met criteria for NAFLD were studied. We offered them following diet: 3-fold meal restricted in red and processed meat, food intake was at 7–9a.m., 1–2p.m. and 6–8p.m. with both LC breakfast and dinner, lunch consisted of LC, proteines, polyunsaturated fatty acids and non-starchy vegetables; there were no snacks during the day. Daily calorie intake was reduced by 20% from baseline. Diet intervention lasted 12 weeks. Self-reported diet records were used to assess dietary intake. No drugs were used during this period. ResultsFinally 47 patients (37 men and 10 women) completed the trial, physical activity didn’t change substantially during this period. After 12 weeks the most significant decreasement were in alanine aminotransferase (ALT) -54.2%, aspartate aminotransferase (AST) -43.7%, HOMAir Index -48.1%, triglycerides -33.3% (relative to baseline). The dynamics for all indicators is statistically significant (P < 0.05). Anthropometric characteristics showed significantly lower sensitivity to our diet therapy compared to clinical indicators, but their dynamics is statistically significant. (P < 0.05). Correlation coefficients - BMI, % Fat, % Visceral Fat, Waist circumference although reduced significantly less than clinical parameters (–6.8% – –19.0%), but show mostly high correlations in their dynamics (r = 0.567 - 0.989, P < 0.05). This indicates the synchronicity of changes in anthropometric indicators. Laboratory indicators do not have such a dependence (low correlation coefficients), which may indicate the absence of a dependence in decrease of some indicators with the decreasement of others. The exception is the high correlation between AST-ALT (r = 0.713) and insulin - HOMA index (r = 0.775), which is clinically determined. ConclusionsThe analysis showed that the most sensitive to our diet therapy were such parametres: ALT, AST and HOMAir index. Therefore, 3-fold LC meal without any snacks and decreased red/processed meat consumption could be good addition or even alternative to pharmacological treatment of MS complicated by NAFLD. Funding SourcesNot funded.

Inadvertent Excessive Soy Intake as Part of a Weight Loss Program Leading to Rapid Growth of Multinodular Goiter

Background: Over the past few decades consumption of soy products has gained popularity in the U.S. in part due to reports of potential health and weight loss benefits. However, concerns have emerged regarding soy as a potential endocrine-disrupting chemical (EDC) leading to thyroid dysfunction amongst other health issues. Studies have shown a potential association of high soy intake with risk of hypothyroidism and simple goiter (1), but less is known regarding its impact on multinodular goiter. Clinical Case: A 33-year-old female originally from Bolivia without significant medical history presented to our endocrine clinic with complaints of right-sided neck swelling. The swelling was insidious in onset, had gradually increased in size over the past 3-4 months, and become uncomfortable. She denied dysphagia, cough, or shortness of breath. Prior to the onset of symptoms, she had enrolled in a commercial weight loss program. The diet program consisted of limiting caloric intake to multiple meal replacement bars during the day followed by a light dinner of fish and non-starchy vegetables. Examination revealed a palpable right-sided thyroid mass and enlarged thyroid gland. Lab work showed normal TSH, fT4, and T3 levels, positive anti-thyroid peroxidase antibody (anti-TPO Ab) 588 (<=35.0 IU/ml), and negative thyroid-stimulating immunoglobulins (TSI). Ultrasound of the thyroid confirmed the presence of a 4 cm dominant right thyroid nodule and multinodular goiter. Subsequent fine-needle aspiration of thyroid nodule was consistent with benign nodular goiter. Upon further investigation, it was discovered that the meal replacement bars contained a significant amount of soy protein resulting in an excessive intake of 20-40 grams of soy protein daily. We discussed treatment options, and the patient declined thyroid surgery in favor of surveillance following discontinuation of the weight loss products. The patient was advised to consume a varied diet and given follow-up appointments for monitoring. Conclusion: Inadvertent excessive soy intake via meal replacement bars may have triggered the rapid growth of a multinodular goiter in our patient despite reported adequate dietary iodine intake. Soy products often contain isoflavones that may exert an adverse effect on the thyroid by inhibition of TPO, disruption of iodine metabolism, and/or estrogenic activity. We advise that caution be exercised with high soy protein consumption especially in patients with underlying risk factors for multinodular goiter.

Intervention of A Personalized Low-Carbohydrate Diet to Reduce HbA1c Level and Weight in Patients with Type 2 Diabetes Using Seed-Based Flour as Replacement for High-Carbohydrate Flour and Foods

Background: Globally, 425 million individuals were living with diabetes in 2017, and the numbers are expected to rise to 693 million by 2045. India, with more than 72 million people with type 2 diabetes mellitus (T2DM) in 2017, was reported to have the second largest population of individuals living with T2DM (https://www.diabetesatlas.org/upload/resources/previous/files/8/IDF_DA_8e-EN-final.pdf). The traditional Indian diet is heavily dependent on carbohydrates, and this acts as an obstacle for diabetes control. Carbohydrate restriction is associated with improvements in glycemic control and a reduction in the risk of the worsening of the disease and its complications. Objective: We investigate the real-world effectiveness of personalized carbohydrate reduction by using seed-based flour (sunflower seeds, pumpkin seeds, watermelon seeds, soya, and flaxseeds) with high-carbohydrate grain-based flour in the food along with remote health coach support for patients on the high glycated hemoglobin (HbA1c) levels and weight loss of patients. Materials and Methods: This study is a nonrandomized outpatient intervention focusing on adults with T2DM. With their consent, patients were enrolled from four clinics across Gujarat, Ahmedabad. The key inclusion criteria focused on patients with Hba1c between 7 and 10 with a body mass index more than 25 kg/m2 from 21 to 60 years of age. The key exclusion criteria were patients with advanced renal, cardiac, or liver dysfunction, pregnancy or planned pregnancy, historical ketoacidosis problems, and patients on SGLT2 inhibitors or pre-mix insulin. The intervention was personalized carbohydrate restriction. Patients were advised to avoid high-carbohydrate food categories such as grains, sugars, and high-carbohydrate fruits. They were advised to take seeds and nuts-based flour, nonstarchy vegetables, sprouts, and berries family fruits. Patients were also provided with recipes and options for all meals of the day. No restriction was made on the intake on nonstarchy vegetables. Patients were also provided with Diahappy Health's Health coach to constantly provide remote support to resolve queries and doubts through phones. Duration of Study: For each participant, the study was carried out for 12 weeks at a stretch. Benefits: The study demonstrates an average 2.34% drop in HbA1c levels in participants who completed the program. There was also an average weight drop of 9 kg achieved in the participants.

US Adults Fall Short of the Dietary Guidelines for Cancer Prevention Regardless of BMI Category

BackgroundCancer risk is determined by specific factors, including body weight and dietary patterns. Accordingly, the World Cancer Research Fund/American Institute for Cancer Research published updated cancer prevention recommendations in 2018 based on comprehensive reviews of modifiable behaviors associated with cancer risk. ObjectiveThe objective of this study was to determine the extent to which US adults meet these evidence-based recommendations and how adherence differs by weight status. DesignThis was a cross-sectional study using nationally representative data from the 2005-2016 National Health and Nutrition Examination Survey (NHANES). Participants/settingDietary intake data for 30,888 adults 18 years and older with normal body mass index (BMI), overweight, or obesity were analyzed. Main outcome measuresDifferences in dietary intakes and the proportion of adults meeting guidelines were compared across BMI categories. Statistical analyses performedLogistic regression and 1-way analysis of covariance were used to analyze differences in adherence to recommendations, controlling for age, sex, race/ethnicity, and family income as a percent of the federal poverty rate. ResultsRegarding fruit and nonstarchy vegetables, 62.8% of adults with normal BMI, 64.5% with overweight, and 70.1% with obesity fell short of recommendations. Regarding whole grains, 67.9% of adults with normal BMI, 70.2% with overweight, and 73.1% with obesity did not meet the recommendation. Regarding red meat, 36.7% of adults with normal BMI, 41.6% with overweight, and 43.5% with obesity consumed >18 oz/week, with a significant difference in mean intakes between adults with normal BMI and obesity (P < .001). Adults with obesity consumed significantly less dietary fiber and more processed meat than adults with normal BMI and overweight (P < 0.001). ConclusionsFew U.S. adults meet cancer prevention recommendations; adults with obesity are significantly less likely to do so. Future research should evaluate compounded risk resulting from obesity and poor dietary patterns inconsistent with current evidence-based guidelines, and inform targeted interventions to address these issues.

Vegetable intake and the risk of bladder cancer in the BLadder Cancer Epidemiology and Nutritional Determinants (BLEND) international study

BackgroundAlthough a potential inverse association between vegetable intake and bladder cancer risk has been reported, epidemiological evidence is inconsistent. This research aimed to elucidate the association between vegetable intake and bladder cancer risk by conducting a pooled analysis of data from prospective cohort studies.MethodsVegetable intake in relation to bladder cancer risk was examined by pooling individual-level data from 13 cohort studies, comprising 3203 cases among a total of 555,685 participants. Pooled multivariate hazard ratios (HRs), with corresponding 95% confidence intervals (CIs), were estimated using Cox proportional hazards regression models stratified by cohort for intakes of total vegetable, vegetable subtypes (i.e. non-starchy, starchy, green leafy and cruciferous vegetables) and individual vegetable types. In addition, a diet diversity score was used to assess the association of the varied types of vegetable intake on bladder cancer risk.ResultsThe association between vegetable intake and bladder cancer risk differed by sex (P-interaction = 0.011) and smoking status (P-interaction = 0.038); therefore, analyses were stratified by sex and smoking status. With adjustment of age, sex, smoking, energy intake, ethnicity and other potential dietary factors, we found that higher intake of total and non-starchy vegetables were inversely associated with the risk of bladder cancer among women (comparing the highest with lowest intake tertile: HR = 0.79, 95% CI = 0.64–0.98, P = 0.037 for trend, HR per 1 SD increment = 0.89, 95% CI = 0.81–0.99; HR = 0.78, 95% CI = 0.63–0.97, P = 0.034 for trend, HR per 1 SD increment = 0.88, 95% CI = 0.79–0.98, respectively). However, no evidence of association was observed among men, and the intake of vegetable was not found to be associated with bladder cancer when stratified by smoking status. Moreover, we found no evidence of association for diet diversity with bladder cancer risk.ConclusionHigher intakes of total and non-starchy vegetable are associated with reduced risk of bladder cancer for women. Further studies are needed to clarify whether these results reflect causal processes and potential underlying mechanisms.

Global Dietary Database 2017: data availability and gaps on 54 major foods, beverages and nutrients among 5.6 million children and adults from 1220 surveys worldwide

BackgroundWe aimed to systematically identify, standardise and disseminate individual-level dietary intake surveys from up to 207 countries for 54 foods, beverages and nutrients, including subnational intakes by age, sex, education...

Low-carbohydrate dietary pattern on glycemic outcomes trial (ADEPT) among individuals with elevated hemoglobin A1c: study protocol for a randomized controlled trial

BackgroundType 2 diabetes mellitus (T2DM) is a major cause of morbidity and mortality globally. Strong evidence supports the importance of diet and other lifestyle factors in preventing T2DM. Among individuals with T2DM, low-carbohydrate diets lead to decreases in hemoglobin A1c (HbA1c). However, research on the effects of low-carbohydrate diets on glycemic outcomes among individuals not currently on glucose-lowering medications who have elevated HbA1c is limited.MethodsThe objective of this randomized controlled trial is to study the effect of a healthy low-carbohydrate diet achieved through behavioral intervention and key food supplementation compared with usual diet on HbA1c and other metabolic risk factors among individuals with HbA1c from 6.0 to 6.9% who are not on glucose-lowering medications. In this parallel trial, 150 participants will be randomized to the intervention or control group for 6 months. The healthy low-carbohydrate diet target is < 40 g of net carbohydrates during the first 3 months and < 40 to 60 net grams for months 3 to 6. This diet is characterized by abundant unsaturated fat and protein, high-fiber foods such as non-starchy vegetables and nuts, and minimal refined carbohydrates. The primary outcome is the difference in HbA1c change from baseline to 6 months in the intervention compared with usual diet group. Secondary outcomes include differences between groups in 6-month changes in fasting glucose, systolic blood pressure, total-to-high-density lipoprotein (HDL) cholesterol ratio, and body weight. Exploratory outcomes include differences in 6-month changes in fasting insulin, homeostasis model assessment of insulin resistance, diastolic blood pressure, waist circumference, and 10-year cardiovascular disease risk. An intention-to-treat analysis will be used.DiscussionWe expect that the results from this study will lead to new approaches for developing and implementing dietary approaches (other than the most commonly used reduced fat diet) that will substantially reduce risk of cardiometabolic disease among adults with or at high risk of T2DM. The study intervention involves behavioral counseling and promotes consumption of dietary components thought to reduce risk of cardiometabolic disease and has expected applicability in clinical practice.Trial registrationClinicalTrials.gov NCT03675360. Registered on September 18, 2018 (prior to enrolment of the first participant).

Socio-economic and racial/ethnic disparities in the nutritional quality of packaged food purchases in the USA, 2008-2018.

To determine whether disparities exist in the nutritional quality of packaged foods and beverage purchases by household income, education and race/ethnicity and if they changed over time. We used Nielsen Homescan, a nationally representative household panel, from 2008 to 2018 (n = 672 821 household-year observations). Multivariate, multilevel regressions were used to model the association between sociodemographic groups and a set of nutritional outcomes of public health interest, including nutrients of concern (sugar, saturated fat and Na) and calories from specific food groups (fruits, non-starchy vegetables, processed meats, sugar-sweetened beverages and junk foods). Household panel survey. Approximately 60 000 households each year from the USA. Disparities were found by income and education for most outcomes and widened for purchases of fruits, vegetables and the percentage of calories from sugar between 2008 and 2018. The magnitude of disparities was largest by education. Disparities between Black and White households include the consumption of processed meats and the percentage of calories from sugar, while no disparities were found between White and Hispanic households. Disparities have been largely persistent, as any significant changes over time have been substantively small. Policies to improve the healthfulness of packaged foods must be expanded beyond SSB taxes, and future research should focus on what mediates the relationship between education and diet so as not to exacerbate disparities.

A WHOLE FOOD, ANTI-INFLAMMATORY DIET ESTABLISHES A BENEFICIAL GUT MICROBIOME IN INFLAMMATORY BOWEL DISEASE PATIENTS

Abstract Background and Aims The inflammatory bowel disease-anti-inflammatory diet (IBD-AID) is a whole food diet designed to favor the development of an anti-inflammatory microbiome and to assist with remission in patients suffering from inflammatory bowel disease (IBD). Herein, we evaluated the effect of the IBD-AID on the gut microbiome and defined the impact of specific foods on bacteria depleted in IBD patients, as well as the clinical response to the IBD-AID. Methods A single-arm, pre-post intervention trial was performed. After a baseline period, a dietary intervention was initiated. We collected stool and blood samples throughout the study and assessed dietary intake and disease severity. We applied advanced computational approaches to define and model complex interactions between the diet, microbiota, and response to the IBD-AID. Results A dense dataset comprising 553 dietary records and 340 stool samples was compiled from 22 subjects participating in the study. The IBD-AID favored bacteria that are normally depleted in IBD cohorts and capable of producing short-chain fatty acids (SCFAs). Consumption of non-starchy vegetables, nuts, and seeds positively correlated with increased abundance of SCFA-producing bacteria, including Roseburia hominis, Eubacterium eligens,and Faecalibacterium prausnitzii. Half of the subjects completing the intervention with high diet adherence (&amp;gt;60%) reported a positive clinical response to the IBD-AID, with a subset of bacterial species predicting diet-induced reduction of symptoms with 67% accuracy. After the intervention, subjects also exhibited a reduction of circulating inflammatory markers. Conclusions The IBD-AID favors the growth of SCFA-producing bacteria that are depleted during IBD dysbiosis. The microbiome signatures emerging after the IBD-AID can predict response to the diet.

Assessing Diet Quality of Indigenous Food Systems in Three Geographically Distinct Solomon Islands Sites (Melanesia, Pacific Islands).

Indigenous Solomon Islanders, like many living in Pacific Small Island Developing States (PSIDS), are currently experiencing the global syndemic—the combined threat of obesity, undernutrition, and climate change. This mixed-method study aimed to assess nutrition transitions and diet quality by comparing three geographically unique rural and urban indigenous Solomon Islands populations. Participants in rural areas sourced more energy from wild and cultivated foods; consumed a wider diversity of foods; were more likely to meet WHO recommendations of >400 g of non-starchy fruits and vegetables daily; were more physically active; and had significantly lower body fat, waist circumference, and body mass index (BMI) when compared to urban populations. Urban populations were found to have a reduced ability to self-cultivate agri-food products or collect wild foods, and therefore consumed more ultra-processed foods (classified as NOVA 4) and takeout foods, and overall had less diverse diets compared to rural populations. Clear opportunities to leverage traditional knowledge and improve the cultivation and consumption of underutilized species can assist in building more sustainable and resilient food systems while ensuring that indigenous knowledge and cultural preferences are respected.

Dietary Contributors to Food Group Intake in Preschool Children Attending Family Childcare Homes: Differences between Latino and Non-Latino Providers

While there are several factors that contribute to the diet quality of children in childcare, one contributing factor in Family Childcare Homes (FCCHs) is the provider’s ethnicity. However, research examining the food items provided in this setting is limited; in particular, with regards to differences between FCCHs of Latino and non-Latino providers. The aim of this study was to identify and describe the food items that contribute to food group intake in preschool-aged children attending FCCHs, and to examine differences by provider ethnicity. This secondary data analysis used baseline data from Healthy Start/Comienzos Sanos: a cluster-randomized trial. Children’s dietary intake was collected using the Dietary Observation in Child Care method and entered into Nutrition Data System for Research software. Food groups were based on the Nutrition Coordinating Center classification. Contribution of food items to their respective food group was calculated as a proportion, using ratio of means and presented as a percentage. Ethnic differences were tested with ANCOVA (p < 0.05) with Bonferroni adjustments for multiple comparisons. All providers (n = 120) were female and 67.5% were Latino. Most fruit consumed by children was in the form of juice (85%), three-fourths of the grains consumed were refined (75%), and half of the sweets consumed were syrup/honey/jelly (50%). Most of the vegetables consumed were non-starchy (61%), nearly three-fourths of dairy consumed was low-fat (71%), and vegetable oils contributed the most to the fats group (89%). Food items differed by provider’s ethnicity, with children cared for by non-Latino providers consuming a higher proportion of fruit juice, animal fats and a lower proportion of legumes (p < 0.001 for all). Children with Latino providers consumed a lower proportion of non-starchy vegetables, low-fat dairy, and nuts/seeds (p < 0.001 for all). FCCH providers could offer more whole fruits and grains and a greater variety of vegetables. Differences by ethnicity suggest providers could benefit from culturally tailored recommendations.

Trends and Dietary Assessment According to Fruit and Vegetable Intake in Korean Elderly People: Analysis Based on the Korea National Health and Nutrition Examination Survey 1998, 2008, and 2018.

The study aimed to examine the 20-year trends in fruit and non-starch/unsalted vegetable intake among the Korean elderly aged 65 years or older based on the Korea National Health and Nutrition Examination Survey (KNHANES) data. A total of 3722 elderly citizens aged 65 years or older who participated in the dietary survey (24-h recall of dietary intake) of the 1998, 2008, and 2018 NHANES were selected as the subjects of this study. Fruit and non-starchy/unsalted vegetable intake increased by approximately 86.53 g over the past 20 years, from 268.27 g in 1998 to 355.8 g in 2018. In particular, 65–74-year-olds had an increased intake by approximately 130.38 g over the past 20 years, from 277.34 g in 1998 to 407.72 g in 2018. In addition, snacks intake significantly increased over the past 20 years (p for trend < 0.001). Intake according to daily meal cooking location increased by approximately 130 g over the past 20 years, from 64.50 g in 1998 to 123.39 g in 2008, and to 198.01 g in 2018. The annual proportion of the total elderly population who meet the amount of vegetable food intake recommended by the World Health Organization (WHO)/World Cancer Research Fund (WCRF) (400 g or more fruits and non-starchy vegetables) increased by approximately 11.28%p (percentage points) over the past 20 years, from 21.78% in 1998 to 24.63% in 2008, and to 33.06% in 2018. The results of this study suggest that more fundamental measures are required to increase the fruit and non-starchy vegetable intake among the elderly. Furthermore, it is thought that the results of this study can be used as basic data in establishing dietary policy. In addition, it is thought that it can be used in developing nutrition education and dietary guidelines for enhancing fruit and vegetable intake.

Randomized Controlled Lifestyle Intervention (LION) Study for Weight Loss and Maintenance in Adults With Obesity—Design and Methods

Introduction: Due to the increasing prevalence of obesity, approaches for a more effective treatment especially in the long-term perspective are needed. However, studies on weight loss and maintenance show heterogeneous results with large inter-individual variations. Therefore, it is of interest to identify factors that contribute to inter-individual differences and predict the success of long-term weight management.Methods and Analysis: The primary outcome of the Lifestyle Intervention (LION) Study is to evaluate the effect of two diets (low carb vs. low fat) and two digital counseling tools (newsletter vs. mobile application) on weight maintenance 12 months after weight loss. The identification of predictive factors (e.g., genetic, epigenetic, physiological, psychological) for the success of weight loss and maintenance is a secondary outcome. Men and women with a body mass index (BMI) between 30.0 and 39.9 kg/m2, aged 18–65 years, and without severe diseases are considered eligible. After phenotyping (e.g., anthropometry, resting metabolic rate, meal challenges, blood parameters) participants will follow a formula-based, low-calorie diet (LCD) for 8 weeks. In addition, the intake of 200 g raw or cooked non-starchy vegetables are allowed per day. Subsequently, 252 participants will be randomized into one of the four intervention groups (low carb/app, low carb/newsletter, low fat/app, low fat/newsletter) for the 12-month weight maintenance step. The study will be concluded after another 12 months of follow-up. Results should provide indications for successful weight management and give insights into the personalized treatment of obesity.Ethics and Dissemination: This study has been granted ethical approval by the local Ethics Review Committee of the School of Medicine, Technical University of Munich (vote: 69/19 S).Trial Registration Number: This study has been registered within ClinicalTrials.gov (NCT04023942) and the German Clinical Trials Register (DRKS00017819).

The Use of Charitable Food Assistance Among Low-Income Households in the United States

BackgroundAbout 11% of US households are food insecure, and many of those households seek charitable food assistance (CFA). However, little is understood about the nutritional composition of the diets of households receiving CFA, or the relationship between CFA and Supplemental Nutrition Assistance Program (SNAP) usage among low-income households. ObjectiveThe aim of the study was to compare the nutritional quality of foods obtained by CFA clients to those of similar nonclients. Furthermore, the study examined the timing of CFA use relative to the timing of SNAP use among CFA clients during the week. Design/participantsAnalyses were conducted using 2012 US Department of Agriculture National Household Food Acquisition and Purchase Survey (FoodAPS), which collected data for 4826 households’ food acquisitions during a 7-day survey week. Sixty-seven households reported using CFAs during the survey week. Main outcomes measureThe nutritional quality of food was measured by the ratios between food acquisition quantities and the US Department of Agriculture Thrifty Food Plan consumption recommendations. The date of SNAP use was compared with that of CFA use for CFA clients who were also SNAP recipients. Statistical analyses performedPropensity score matching was utilized to construct a matching sample of CFA clients and nonclients. T tests were used to compare the means of variables. ResultsCFA clients were more likely to be food insecure (48% vs 28%, P < .001) and less likely to have access to a car (61.2% vs 84.8%, P < .001) than CFA nonclients. CFAs represent an important source of foods for CFA clients, taking up 28% of their total food at home acquisitions. CFA clients obtained more nonstarchy vegetables than matched nonclients. Furthermore, among the 45% of CFA clients who also participated in SNAP, the majority (52.4%) of them used SNAP benefits within 10 days of SNAP benefits distribution while most (67.9%) of those households used CFAs starting on day 11 or later after SNAP benefits were allocated. ConclusionsCFAs provide a substantial portion of the diets of their clients and, in particular, for foods that constitute components of healthy diets. For the proportion of CFA clients who received SNAP, this study finds evidence that CFA clients relied more on CFAs when their SNAP benefits were likely to run low.

The Ketogenic Diet in the Treatment of Post-concussion Syndrome-A Feasibility Study.

Concussion is the most common form of mild traumatic brain injury (mTBI). Although most patients' symptoms resolve within a month, patients with post-concussion syndrome (PCS) may continue to experience symptoms for years and have limited treatment options. This pilot study assessed the feasibility and symptom-related effects of a ketogenic diet (KD) in patients with PCS symptoms. The Ketogenic Diet in Post-Concussion Syndrome (KD-PCS) was a single-arm trial of a 2-month KD high in non-starchy vegetables and supplemented with medium-chain triglyceride (MCT) oil. Macronutrient targets were ≥70% fat, ≤10% carbohydrate, and the remainder as protein as energy. We assessed feasibility by daily self-reported measure of urine acetoacetate and collection of 3-day food records and serum beta-hydroxybutyrate at multiple timepoints. We assessed symptoms by administering the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and Modified Balance Error Scoring System (M-BESS) at baseline and month 2 and the Post-Concussion Symptom Scale (PCSS) at baseline, month 1, and month 2. Fourteen participants enrolled in the KD-PCS. Twelve participants completed the study and 11 implemented the KD (73% fat, 9% carbohydrate, and 18% protein) and achieved ketosis. One participant complained of MCT-related diarrhea that resolved and another reported nausea and fatigue that resulted in withdrawal from the study. Among compliant participants, the visual memory domain of the ImPACT improved by 12 points (p = 0.02) and PCSS scores improved by 9 points, although not statistically significant. This pilot trial suggests that the KD is a feasible experimental treatment for PCS and justifies further study of its efficacy.

Fruit and Vegetable Purchasing Patterns and Supplemental Nutrition Assistance Program Participation: Findings From a Nationally Representative Survey

BackgroundPrevious studies suggest that Supplemental Nutrition Assistance Program (SNAP) participants purchase less produce than nonparticipants. Whether this is due to buying smaller amounts or to being less likely to buy any produce is unclear. Purchase patterns may also differ over the monthly distribution cycle. ObjectiveTo examine differences in the likelihood and amounts of fruits and vegetables purchased between SNAP household compared with nonparticipant households and to determine differences in produce purchases among SNAP households at different time points in the monthly distribution cycle. DesignCross-sectional. Participants/settingData from 4708 households in the National Household Food Acquisition and Purchase Survey (April 2012 to January 2013). Participants recorded all foods acquired over 7 days. Main outcome measuresFruits and vegetables acquired over a 7-day period. Statistical analyses performedWeighted logistic and linear regression models adjusting for household and primary respondent characteristics were used to compare odds of purchasing fruits and vegetables and amounts purchased across 3 categories: SNAP participants, SNAP-eligible nonparticipants, and ineligible nonparticipants. SNAP participants were further subdivided according to weeks since last receiving benefits. ResultsIn adjusted analyses, SNAP participants and nonparticipants were similarly likely to purchase fruits and vegetables. However, SNAP households within a week of receiving benefits were more likely than SNAP households later in the benefit cycle to buy fruit overall, especially frozen or canned fruit, and vegetables overall, including fresh, frozen or canned, starchy, and nonstarchy vegetables (fruit odds ratio [OR] 1.68, 95% confidence interval [CI] 1.12, 2.53; vegetable OR 1.63, 95% CI 1.04, 2.55 vs households in middle of cycle). In contrast, those in the last week of the benefit cycle were less likely to purchase fruit, especially fresh fruit, and vegetables, especially fresh and nonstarchy vegetables (fruit OR 0.58, 95% CI 0.35, 0.94; vegetable OR 0.58, 95% CI 0.42, 0.79 vs. households in middle of cycle), and when they bought vegetables, they bought significantly less. ConclusionConsidering all SNAP households together at different points in their distribution cycle masks substantial declines in purchasing fruits and vegetables over the monthly cycle.

Influencia del método de deshidratación sobre la calidad de snacks de zapallito redondo [Cucurbita maxima var. Zapallito (Carr.) Millán)

El creciente interés por los snacks de vegetales no amiláceos, preparados sin fritura se explica por su menordensidad calórica, respecto a la papa deshidratada y frita. Los métodos convencionales de secado a altatemperatura en ciertos casos pueden provocar pérdidas de componentes bioactivos. Es por ello que existeinterés en la búsqueda de nuevos métodos de procesamiento que reduzcan el desperdicio de estos productos. En este trabajo, se evaluó la calidad (antioxidantes fenólicos, carotenoides, azúcares, acidez, color, aceptabilidad sensorial e higroscopicidad) de snacks de zapallito redondo obtenidos por dos métodos diferentes: 1) secado con aire caliente (SAC) o 2) por un método combinado de deshidratación osmótica (DO) con NaCl seguido de una etapa de secado por aire caliente (DO+SAC). Dependiendo de la concentración de NaCl empleada, la etapa de DO permitió reducir la humedad inicial del vegetal en 15-30%. La incorporación de un pre-tratamiento de DO antes del secado por aire caliente no afectó la acidez, azúcares ni contenido de compuestos fenólicos del producto final. Los snacks obtenidos por el método combinado DO+SAC, mostraron mejor color y aceptabilidad sensorial, mayor nivel de carotenoides extraíbles y menor higroscopicidad que los producidos por SAC. Los resultados del presente trabajo muestran que los tratamientos combinados de DO y aire caliente, resultan en snacks de zapallito redondo con mejores propiedades físicas (color, higroscopicidad), nutricionales (carotenoides) y sensoriales (aceptabilidad) que aquellos obtenidos sólo por secado convencional con aire caliente.